Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Dec 6;18(1):931.
doi: 10.1186/s13018-023-04427-8.

Association of hardware removal with secondary osteonecrosis following femoral neck fractures: a systematic review and meta-analysis

Qilong Jiang #  1 , Yu Deng #  1 , Yang Liu #  1 , Zhi Zhao  1 , Yu Chen  1 , Xinwen Bai  2 , Hao Hong  3
Affiliations
Meta-Analysis

Association of hardware removal with secondary osteonecrosis following femoral neck fractures: a systematic review and meta-analysis

Qilong Jiang et al. J Orthop Surg Res. .

Abstract

Background: It has been controversial that whether hardware removal will increase the risk of osteonecrosis of femoral head (ONFH) in fracture-healed patients who underwent internal fixation for femoral neck fractures (FNFs). This meta-analysis aimed to clarify the association of hardware removal with secondary hardware removal-induced ONFH (HR-ONFH).

Methods: Four electronic databases (PubMed, Embase, Web of Science, Cochrane Library) were searched for eligible studies published up to March 10, 2023. Studies reporting the relative risk of hardware status (i.e., risk rate, odds ratio [OR], or hazard ratio [HR]) were included. Newcastle-Ottawa scale (NOS) was used to assess risk of bias of included observational studies. Review Manager software was used to pool ORs and adjusted ORs.

Results: Five studies were included into quantitative synthesis. Hardware removal was associated with a reduced risk of HR-ONFH in the synthesis of crude odds ratios (OR, 0.62, 95% CI 0.39-0.96). In the synthesis of adjusted odds ratios, hardware removal was associated with an increased risk of HR-ONFH (OR, 1.76, 95% CI 1.23-2.51).

Conclusion: This study demonstrates that hardware removal was associated with an increased incidence of HR-ONFH in fracture-healed patients who underwent internal fixation due to FNFs.

Keywords: Femoral neck fracture; Hardware removal; Internal fixation; Meta-analysis; Osteonecrosis of femoral head.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram for systematic reviews
Fig. 2
Fig. 2
Synthesis of crude odds ratios
Fig. 3
Fig. 3
Synthesis of crude odds ratios after sensitivity analysis
Fig. 4
Fig. 4
Synthesis of adjusted odds ratios
Fig. 5
Fig. 5
Synthesis of adjusted odds ratios after sensitivity analysis
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

References

    1. Anagnostis P, Paschou SA, Goulis DG. Management of acute hip fracture. N Engl J Med. 2018;378(10):971–972. doi: 10.1056/NEJMc1800044. - DOI - PubMed
    1. Ai ZS, Gao YS, Sun Y, Liu Y, Zhang CQ, Jiang CH. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients. J Orthop Sci. 2013;18(2):271–276. doi: 10.1007/s00776-012-0331-8. - DOI - PubMed
    1. Kim CH, Shin M, Lee D, Choi SJ, Moon DH. Hidden osteonecrosis of the femoral head after healed femoral neck fractures: magnetic resonance imaging study of 58 consecutive patients. Arch Orthop Trauma Surg. 2022;142(7):1443–1450. doi: 10.1007/s00402-021-03802-6. - DOI - PubMed
    1. Xin P, Li Z, Pei S, Shi Q, Xiao L. The incidence and risk factors for femoral head necrosis after femoral neck fracture in pediatric patients: a systematic review and meta-analysis. J Orthop Surg Res. 2023;18(1):22–35. doi: 10.1186/s13018-023-03502-4. - DOI - PMC - PubMed
    1. Wang T, Sun JY, Zha GC, Jiang T, You ZJ, Yuan DJ. Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures. Orthopedics. 2014;37(12):1117–1123. doi: 10.3928/01477447-20141124-60. - DOI - PubMed

MeSH terms