Multiple cannulated screws vs. dynamic hip screws for femoral neck fractures : A meta-analysis

Abstract

Objective: Various fixation devices have been reported for stabilization of femoral neck fractures. Numerous studies on arthroplasty versus internal fixation devices in the treatment of femoral neck fractures have been performed, but the optimal approach for internal fixation has not been analyzed.

Methods: A meta-analysis and system evaluation were performed to compare clinical effects. We searched PubMed, Embase, Cochrane Library, and Web of Science^TM for randomized, controlled trials (RCTs) comparing multiple cannulated screws (MCS) with dynamic hip screws (DHS) and analyzed the failure rate of operations, the reoperation rate, and postoperative complications. Risk ratios (RRs) and mean differences from each trial were pooled using random effects or fixed effects models, depending on study heterogeneity. The analysis was performed using RevMan5.2.

Results: In this meta-analysis, 592 femoral neck fractures from 7 studies were assessed, and the meta-analysis results indicated significant differences in reoperation (RR 1.44, 95% confidence interval [CI] 1.10-1.88, P = 0.008) and failure rate (RR 2.28, 95% CI 1.10-4.72, P = 0.03), but no significant differences in the rate of postoperative complications between the MCS group and DHS group.

Conclusions: DHS fixation has a larger skin incision and more soft tissue dissection, but it is associated with lower rates of fixation failure, reoperation, and overall rate of postoperative complications, and its use in elderly patients with osteoporosis is still recommended due to simplicity, efficacy, and high overall success rate. Multicenter RCTs with large samples are needed to better understand the comparative efficacy and safety of MCS and DHS in femoral neck fractures of restricted fracture type.

Keywords: Fracture fixation, internal; Internal fixators; Postoperative complications; Reoperation; Treatment failure.