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Caldaria A, Gambuti E, Biagi N, Spadoni E, Saracco A, Massari L, Caruso G. Comparison of femoral neck system versus cannulated cancellous screws for the fixation of femoral neck fracture: a single-center retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3207-3213. [PMID: 39085468 PMCID: PMC11377608 DOI: 10.1007/s00590-024-04051-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/21/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION The dynamic hip screw (DHS) and cannulated compression screws (CCS) have been the two implants most frequently employed for the fixation of femoral neck fractures. The objective of this study is to compare clinical and radiographic outcomes between patients treated with the FNS and those treated with CCS. MATERIAL AND METHODS We conducted a retrospective analysis of a consecutive series of femoral neck fractures treated with FNS or CCS between May 2019 and June 2022. The study included 144 patients who met the inclusion criteria. Collected data encompassed age, sex, Garden fracture classification, Pauwels classification, duration of surgery, length of hospital stays, Harris Hip Score (HHS), complications, and injured side. RESULTS The FNS group comprised 70 patients, while the CCS group consisted of 74 patients. The operation time was 43.6 ± 12.09 min for the FNS group and 56.47 ± 22.42 min for the CCS group. At the end of the follow-up, the mean HHS was 87.07 ± 11.77 for the FNS group and 76.20 ± 13.64 for the CCS group. The mean reduction in hemoglobin levels from pre- to post-surgery was 1.05 mg/dl in the FNS group and 0.87 mg/dl in the CCS group. The reintervention rate was 8.1% for the CCS group and 2.85% for the FNS group. CONCLUSION The FNS does not demonstrate superiority over CCS regarding femoral neck shortening, complication rate, and reduction in hemoglobin levels. However, FNS does appear superior to CCS in terms HHS, operation time, and reoperation rate.
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Affiliation(s)
- A Caldaria
- Department of Orthopedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, 00189, Rome, Italy
- Faculty of Medicine and Surgery, UniCamillus-Saint Camillus Internation University of Health and Medical Science, 00131, Rome, Italy
| | - E Gambuti
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - N Biagi
- Henley Business School, Business Informatics System and Accounting, Information Research Centre, University of Reading, Reading, UK
| | - E Spadoni
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - A Saracco
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - L Massari
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - G Caruso
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy.
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy.
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Zhou Y, Li Z, Lao K, Wang Z, Zhang L, Dai S, Fan X. Femoral neck system vs. cannulated screws on treating femoral neck fracture: a meta-analysis and system review. Front Surg 2023; 10:1224559. [PMID: 37533744 PMCID: PMC10390772 DOI: 10.3389/fsurg.2023.1224559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Objective This meta-analysis aimed to compare the relative safety and efficacy of cannulated compression screw (CCS) and femoral neck system (FNS) in treating patients with femoral neck fractures and to provide evidence-based medical evidence for FNS in treating femoral neck fractures. Methods PubMed, Embase, Cochrane, and China National Knowledge Infrastructure databases were searched to collect outcomes related to femoral neck fractures treated with FNS and CCS, including time to fracture healing, incidence of non-union, incidence of osteonecrosis of the femoral head, incidence of failure of internal fixation, rate of femoral neck shortening, Harris hip score, Barthel index, operative time, intraoperative blood loss, fluoroscopy frequency, and complications. A meta-analysis was performed using RevManv5.4 (The Cochrane Collaboration) and Stata v14.0 software. Results This analysis included 21 studies involving 1,347 patients. The results showed that FNS was superior to CCS in terms of fracture healing time [mean difference (MD) = -0.75, 95% CI = (-1.04, -0.46), P < 0.05], incidence of bone non-union [odds ratio (OR) = 0.53, 95% CI = (0.29, 0.98), P = 0.04], incidence of osteonecrosis of the femoral head [OR = 0.49, 95% CI = (0.28, 0.86), P = 0.01], incidence of internal fixation failure [OR = 0.30, 95% CI = (0.18, 0.52), P < 0.05], rate of femoral neck shortening [OR = 0.38, 95% CI = (0.27, 0.54), P > 0.05], Harris hip score [MD = 3.31, 95% CI = (1.99, 4.63), P < 0.001], Barthel index [MD = 4.31, 95% CI = (3.02, 5.61), P < 0.05], intraoperative bleeding [MD = 14.72, 95% CI = (8.52, 20.92), P < 0.05], fluoroscopy frequency [OR = 0.53, 95% CI = (0.29, 0.98), P = 0.04], and complications [OR = 0.31, 95% CI = (0.22, 0.45), P < 0.05]. The difference between FNS and CCS in operative time was not statistically significant [MD = -2.41, 95% CI = (-6.88, 2.05), P = 0.29]. Conclusion FNS treatment of femoral neck fracture can shorten the fracture healing time; reduce the incidence and translucent rate of bone non-union, osteonecrosis of the femoral head, and internal fixation failure; reduce intraoperative blood loss and postoperative complications; and improve hip joint function and activity. We are confident in the findings that FNS, an effective and safe procedure for internal fixation of femoral neck fractures, is superior to CCS.
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Affiliation(s)
- Yimin Zhou
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Zongyang Li
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Kecheng Lao
- Department of Osteoarticular and Sports Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Zixiu Wang
- College of Pharmacy, Gannan Medical University, Ganzhou, China
| | - Li Zhang
- Department of Rehabilitation and Health, Fujian Vocational College of Bio-engineering, Fuzhou, China
| | - Shiyou Dai
- Department of Osteoarticular and Sports Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Xiao Fan
- Department of Osteoarticular and Sports Medicine, Qingdao Municipal Hospital, Qingdao, China
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Jiang J, Chen J, Xing F, Liu H, Xiang Z. Comparison of femoral neck system versus cannulated screws for treatment of femoral neck fractures: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:285. [PMID: 37055749 PMCID: PMC10099821 DOI: 10.1186/s12891-023-06378-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/27/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Recently, some studies on the efficacy of the femoral neck system (FNS) in treating femoral neck fractures (FNFs) have been published. Therefore, a systematic review was performed to clarify the efficacy and safety of FNS versus cannulated screws (CS) for the treatment of FNFs. METHOD The PubMed, EMBASE, and Cochrane databases were systematically searched for studies comparing FNS and CS fixations in FNFs. Intraoperative indicators, postoperative clinical indicators, postoperative complications, and postoperative scores were compared between the implants. RESULTS A total of eight studies were included in the study, involving 448 FNFs patients. The results showed that patients in FNS group were significantly lower than the CS group in the number of X-ray exposures (WMD = -10.16; 95% CI, -11.44 to -8.88; P < 0.001; I2 = 0%), fracture healing time (WMD = -1.54; 95% CI, -2.38 to -0.70; P < 0.001; I2 = 92%), length of femoral neck shortening (WMD = -2.01; 95% CI, -3.11 to -0.91; P < 0.001; I2 = 0%), femoral head necrosis (OR = 0.27; 95% CI, 0.08 to 0.83; P = 0.02; I2 = 0%), implant failure/cutout (OR = 0.28; 95% CI, 0.10 to 0.82; P = 0.02; I2 = 0%), and Visual Analog Scale Score (WMD = -1.27; 95% CI, -2.51 to -0.04; P = 0.04; I2 = 91%). And the Harris Score was significantly higher in the FNS group than in the CS group (WMD = 4.15; 95% CI, 1.00 to 7.30; P = 0.01; I2 = 89%). CONCLUSIONS Based on this meta-analysis, FNS shows better clinical efficacy and safety in treating FNFs compared to CS. However, due to the limited quality and number of included studies and the high heterogeneity of the meta-analysis; large samples and multicenter RCTs are needed to confirm this conclusion in the future. LEVEL OF EVIDENCE II, Systematic review and Meta-analysis. TRIAL REGISTRATION PROSPERO CRD42021283646.
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Affiliation(s)
- Jiabao Jiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jialei Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Fei Xing
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Zhou Xiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Nan C, Ma L, Liang Y, Li Y, Ma Z. Mechanical effects of sagittal variations on Pauwels type III femoral neck fractures treated with Femoral Neck System(FNS). BMC Musculoskelet Disord 2022; 23:1045. [PMID: 36457095 PMCID: PMC9714141 DOI: 10.1186/s12891-022-06016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The spatial position of internal fixation play a role in determining the stability of internal fixations, both in clinical practice and research. Researchers have examined the stability of FNS (Femoral neck system) in the presence of coronal plane changes. In our knowledge, due to the biomechanical limitations of the specimens, there are no mechanical studies on the sagittal variation of FNS. This study aimed to investigate the biomechanical behavior of sagittal variations on Pauwels type III femoral neck fractures treated with FNS through finite element analysis. METHODS Finite element models including Pauwels type III femoral neck fracture and FNS were reconstructed. Five fracture models(superior, central, inferior, anterior, posterior) were created in accordance with the bolt location in the sagittal plane within the femoral head. Equivalent stress, shear stress, and total deformation of each model under the same physiological load were recorded. RESULTS According to the results, the central model exhibited the slightest stress and displacement, with the exception of the superior model. The internal fixation stress of the superior model was smaller than that of the central model. However, the maximum interfragmentary stress, total deformation and shear resistance area of the superior model was larger than that of the central model. CONCLUSIONS Central position of FNS in the sagittal plane allowed axial compression while reducing shear stress of internal fixation and interfragmentary equivalent stress. Off-axis fixation of the femoral neck increased the strain area and total displacement of the bone, raising the risk of fixation failure. Therefore, the central placement of FNS may be a better surgical target in the treatment of femoral neck fractures.
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Affiliation(s)
- Chong Nan
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China
| | - Liang Ma
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China
| | - Yuechuang Liang
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China
| | - Yanjun Li
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China ,Baoding Digital Orthopaedic Key Laboratory, Baoding, 071000 Hebei Province China
| | - Zhanbei Ma
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China ,Baoding Digital Orthopaedic Key Laboratory, Baoding, 071000 Hebei Province China
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冀 家, 杨 博, 王 敏, 董 亮, 黄 小. [Research progress of femoral neck system in treatment of femoral neck fracture in young and middle-aged patients]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1434-1439. [PMID: 36382464 PMCID: PMC9681595 DOI: 10.7507/1002-1892.202205092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 01/25/2023]
Abstract
Objective To summarize the research progress of femoral neck system (FNS) in the treatment of femoral neck fracture in young and middle-aged patients. Methods The literature on FNS at home and abroad in recent years was extensively reviewed, and the results of mechanical and clinical studies on FNS were summarized based on clinical experience. Results FNS has good mechanical stability, which can reduce complications such as femoral neck shortening, internal fixation failure, and varus caused by mechanical instability. At present, FNS is mainly selected for comparison with cannulated compression screws and dynamic hip screws in clinical research. The results show that FNS has the advantages of minimally invasive, short operation time, less intraoperative fluoroscopy, earlier postoperative weight-bearing and fracture healing, and better hip function recovery. Conclusion As a new internal fixator, FNS has achieved satisfactory results in the current research. FNS has good mechanical advantages, which is beneficial to fracture healing and the recovery of hip joint function after operation. However, whether FNS can reduce the incidence of nonunion and osteonecrosis of the femoral head remains to be further clarified.
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Affiliation(s)
- 家琛 冀
- 西安医学院（西安 710068）Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China
- 西安交通大学医学院附属红会医院骨科（西安 710054）Department of Orthopedics, Honghui Hospital Affiliated to Medicine College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China
| | - 博 杨
- 西安医学院（西安 710068）Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China
- 西安交通大学医学院附属红会医院骨科（西安 710054）Department of Orthopedics, Honghui Hospital Affiliated to Medicine College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China
| | - 敏 王
- 西安医学院（西安 710068）Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China
| | - 亮 董
- 西安医学院（西安 710068）Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China
| | - 小强 黄
- 西安医学院（西安 710068）Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China
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Wu ZF, Luo ZH, Hu LC, Luo YW. Efficacy of the femoral neck system in femoral neck fracture treatment in adults: A systematic review and meta-analysis. World J Clin Cases 2022; 10:11454-11465. [PMID: 36387785 PMCID: PMC9649536 DOI: 10.12998/wjcc.v10.i31.11454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/19/2022] [Accepted: 10/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Controversy remains around the available choices for the internal fixation of a femoral neck fracture. The femoral neck system (FNS) was developed in 2018 and has been widely applied since then as it can provide rigid fixation stability with less damage to the bone mass around the fracture. However, no systematic reviews and meta-analyses have investigated the efficacy of the FNS in comparison with that of traditional internal fixation in the treatment of femoral fractures.
AIM To assess the efficacy of the FNS in comparison with that of cannulated compression screws (CCS) in the treatment of femoral fractures through systematic review and meta-analysis.
METHODS Five electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang) were searched from the earliest publication date to December 31, 2021. Reference Citation Analysis (https://www.referencecitationanalysis.com/) was used to check the results and further analyze the related articles. Controlled trials were included if the FNS was applied for the femoral neck fracture in adults and if it was compared with CCS for the achievement of internal fixation. The measurement outcomes included the required operation time, observed patient’s blood loss, extent of fracture healing, patient’s Harris Hip score (HHS) at the last follow-up, and records of any complications (such as failure of internal fixation, femoral neck shortness, avascular necrosis of the femoral head, and delayed union or nonunion).
RESULTS Ten retrospective controlled studies (involving 711 participants) were included in this meta-analysis. The meta-analysis showed that compared with CCS, use of the FNS could not decrease the operation time [standardized mean difference (SMD): -0.38, 95% confidence interval (CI): -0.98 to 0.22, P = 0.21, I2 = 93%), but it could increase the intraoperative blood loss (SMD: 0.59, 95%CI: 0.15 to 1.03, P = 0.009, I2 = 81%). The pooled results also showed that compared with CCS, the FNS could better promote fracture healing (SMD: -0.97, 95%CI: -1.65 to -0.30, P = 0.005, I2 = 91%), improve the HHS at the last follow-up (SMD: 0.76, 95%CI: 0.31 to 1.21, P = 0.0009, I2 = 84%), and reduce the chances of developing femoral neck shortness (OR: 0.29, 95%CI: 0.14 to 0.61, P = 0.001, I2 = 0%) and delayed union or nonunion (OR: 0.47, 95%CI: 0.30 to 0.73, P = 0.001; I2 = 0%) in adult patients with femoral neck fractures. However, there was no statistically significant difference between the FNS and CCS in terms of failure of internal fixation (OR: 0.49, 95%CI: 0.23 to 1.06, P = 0.07, I2 = 0%) and avascular necrosis of the femoral head (OR: 0.46, 95%CI: 0.20 to 1.10, P = 0.08, I2 = 0%).
CONCLUSION Compared with CCS, the FNS could decrease the chances of developing femoral neck shortness and delayed union or nonunion in adults with femoral neck fractures. Simultaneously, it could accelerate fracture healing and improve the HHS in these patients.
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Affiliation(s)
- Zhi-Fang Wu
- Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), Guangzhou 510378, Guangdong Province, China
| | - Zi-Heng Luo
- Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), Guangzhou 510378, Guangdong Province, China
| | - Liu-Chao Hu
- Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), Guangzhou 510378, Guangdong Province, China
| | - Yi-Wen Luo
- Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), Guangzhou 510378, Guangdong Province, China
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Patel S, Kumar V, Baburaj V, Dhillon MS. The use of the femoral neck system (FNS) leads to better outcomes in the surgical management of femoral neck fractures in adults compared to fixation with cannulated screws: A systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03407-8. [PMID: 36201031 DOI: 10.1007/s00590-022-03407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Intracapsular femoral neck fractures are challenging to treat, with outcomes depending on the quality of reduction, and the stability of fixation. Cannulated cancellous screws (CCS) are the most commonly used implants to fix these fractures, but failure rates are significant. The recently introduced femoral neck system (FNS) may be a better option than CCS fixation and this review attempts to compare the results. METHODS Four electronic databases were searched for eligible articles that had comparative data on the outcomes of fixation of adult femoral neck fractures with FNS and CCS. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% confidence intervals. RESULTS Eight studies with 509 cases having a mean age of 50.8 years were included for final analysis. FNS was found to be associated with significantly reduced complication rates (p < 0.001), decreased incidence of postoperative femoral neck shortening (p < 0.001), quicker time to fracture union (p = 0.002), and better functional outcome scores (p < 0.001) compared to cannulated screws. FNS was also associated with a shorter operating time (mean difference 6.65 min) although not statistically significant (p = 0.24). CCS group had significantly reduced mean blood loss (p < 0.001). CONCLUSION The available literature supports FNS as a better option for adult femoral neck fractures, with a lower complication rate, quicker union, and better clinical outcomes. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Sandeep Patel
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishnu Baburaj
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lu Y, Huang Z, Xu Y, Huang Q, Ren C, Li M, Li Z, Sun L, Xue H, Zhang K, Wang Q, Ma T. Femoral neck system versus cannulated screws for fixation of femoral neck fracture in young adults: a systematic review and meta-analysis. Am J Transl Res 2022; 14:5480-5490. [PMID: 36105033 PMCID: PMC9452327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Femoral neck fracture treatment in young adults remains controversial. Cannulated screws (CS) and femoral neck system (FNS) are well-accepted methods for femoral neck fracture treatment; however, these methods are associated with complications. This meta-analysis aimed to evaluate the relative safety and effectiveness of CS and FNS for treating young patients with femoral neck fractures. METHODS We searched the following sources for studies that compared CS and FNS fixation: Cochrane library, Embase, PubMed, Web of Science, Wanfang data, China National Knowledge Infrastructure, China Biology Medicine disc, and Chinese Science and Technology Journals. The outcomes were surgical and prognostic results and complications. RESULTS This meta-analysis included eight studies. The pooled results revealed that the two fixation methods were similar in terms of the operation time, length of hospital stay, healing time, intraoperative blood loss, non-union, femoral head necrosis, and internal fixation cut-out. Compared with CS fixation, FNS fixation required fewer intraoperative fluoroscopies and had better Harris Hip Score, earlier weight-bearing, lower number of total complications, lesser femoral neck shortening, and lesser extent of nail retreat. CONCLUSION FNS fixation outperforms CS fixation in terms of intraoperative fluoroscopies, Harris Hip Score, and morbidity in young patients with femoral neck fractures. Clinicians should consider FNS as a first choice in treating femoral neck fracture in young adults, except where this approach is contraindicated.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Zhilong Huang
- Department of Orthopaedic Surgery, The Nuclear Industry 417 HospitalXi’an 710600, Shaan’xi Province, China
| | - Yibo Xu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Ming Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Hanzhong Xue
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
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Tian P, Kuang L, Li ZJ, Xu GJ, Fu X. Comparison Between Femoral Neck Systems and Cannulated Cancellous Screws in Treating Femoral Neck Fractures: A Meta-Analysis. Geriatr Orthop Surg Rehabil 2022; 13:21514593221113533. [PMID: 35832467 PMCID: PMC9272162 DOI: 10.1177/21514593221113533] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/21/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background We performed a meta-analysis to compare the efficacy and safety of the femoral neck system (FNS) with cannulated cancellous screws (CCSs) in treating femoral neck fractures (FNFs) in controlled clinical trials. Methods Eligible scientific articles published prior to September 2021 were retrieved from the PubMed, Web of Science, Springer, ScienceDirect and Cochrane Library databases. The statistical analysis was performed with RevMan 5.1. Results Seven retrospective studies met the inclusion criteria. Meta-analysis showed that there were significant differences in perioperative blood loss, the postoperative Harris score, healing time, fluoroscopy frequency, total complications, femoral head necrosis, femoral neck shortening and screw cutout. No significant differences were found regarding operation time, length of hospital stay or nonunion between the two groups. Conclusion Compared with CCSs, the FNS showed better clinical efficacy and fewer complications in treating FNFs. Due to the limited quality and data of the currently available evidence, more high-quality randomized controlled trials are needed.
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Affiliation(s)
- Peng Tian
- Department of Traumatic Orthopedics, Tianjin Hospital, Tianjin, P.R. China
| | - Lan Kuang
- Department of Orthopedics Emergency, Tianjin Hospital, Tianjin, P.R. China
| | - Zhi-Jun Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Gui-Jun Xu
- Department of Orthopedics, Tianjin Hospital, Tianjin, P.R. China
| | - Xin Fu
- Department of Orthopedics, Tianjin Hospital, Tianjin, P.R. China
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