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Review
. 2020 Sep 21;15(1):433.
doi: 10.1186/s13018-020-01958-2.

The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis

Shuai Cui  1 , Dehui Wang  1 , Xuejie Wang  2 , Zehui Li  2 , Wenlai Guo  3
Affiliations
Review

The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis

Shuai Cui et al. J Orthop Surg Res. .

Abstract

Background: Femoral neck fractures are common fractures in the elderly. Common treatment options include internal fixation (IF) and hemiarthroplasty (HA). However, the clinical application of these two options is always controversial due to the potential clinical trauma, postoperative function, early complications, and other factors.

Materials and methods: Randomized controlled trials and cohort studies comparing screw fixation and hemiarthroplasty in elderly patients with displaced femoral neck fractures were extracted from databases such as PubMed, Web of Science, EMBASE, and Cochrane. The revised Jadad scale or NOS treatment evaluation form was used to evaluate the quality of the included studies. After extracting the data, the standard deviation of continuous data and the relative risk of binary data were used. The operation time, blood loss during operation, EQ-5D (EuroQol-5 Dimension) score, mortality rate, reoperation rate, and postoperative common complications were reviewed using Review Manager software (RevMan 5.3) were compared.

Results: There were 7 randomized controlled trials and 5 cohort studies. The results showed that the operation time, intraoperative blood loss, and short-term EQ-5D score of the internal fixation group were lower than those of the hemi-hip replacement group, but the reoperation rate was higher. There was no statistically significant difference in mortality and common complications such as deep vein thrombosis, pulmonary embolism, infection, and pressure sores during short-term follow-up.

Conclusions: In the treatment of elderly femoral neck fractures, the screw internal fixation group has shorter operation time and less intraoperative bleeding, and the perioperative advantage is more obvious. However, the hemi-hip replacement group had more advantages in postoperative functional scoring and reoperation.

Keywords: Femoral neck fractures; Hemiarthroplasty; Internal fixation; Meta-analysis; The elderly.

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Conflict of interest statement

The authors of this manuscript have no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Flowchart of literature screening
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Forest map of operation time
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Forest map of intraoperative blood loss
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Forest map of 1-year EQ-5D score
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Forest map of 2-year EQ-5D score
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Forest map of 1-year mortality
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Forest map of 2-year mortality
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Forest chart of reoperation rate
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Forest map of the incidence of deep vein thrombosis
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Forest map of pulmonary embolism
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Forest map of postoperative infection
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Forest map of pressure sores
See this image and copyright information in PMC

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