TY - JOUR
T1 - Internal Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures
T2 - A Systematic Review and Meta-Analysis
AU - Sattari, Shahab Aldin
AU - Guilbault, Ryan
AU - MacMahon, Aoife
AU - Salem, Hytham S.
AU - Khanuja, Harpal S.
N1 - Publisher Copyright:
© 2023 Wolters Kluwer Health, Inc.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Objective:To compare internal fixation (IF) versus hemiarthroplasty (HA) for elderly individuals (ie, older than 65 years) with nondisplaced (ie, Garden type I or II) femoral neck fracture (FNF).Data Source:We searched English literature of MEDLINE, PubMed, and Embase from inception to December 4, 2021.Study Selection:Eligibility criteria were randomized controlled trials (RCTs) compared IF versus HA for elderly individuals with nondisplaced FNF. Primary outcomes were Harris hip score (HHS), quality of life per European Quality of Life 5 Dimension (EQ-5D), and mortality. Secondary outcomes were complications, reoperation, intraoperative bleeding, operation duration, and length of hospital stay.Data Extraction:Two authors separately extracted data and assessed the risk of bias of the included studies using Cochrane risk-of-bias tool.Data Synthesis:Three RCTs yielding 400 patients were enrolled, of which 203 (50.7%) underwent IF. Internal fixation was inferior to HA with respect to 6-month HHS [mean difference (MD) = -8.28 (-14.46, -2.10), P = 0.009] and 1-year EQ-5D [MD = -0.07 (-0.14, -0.00), P = 0.04]. The 2 techniques were comparable regarding length of hospital stay (day), HHS at 1 and 2 years, EQ-5D at 2 years, and mortality. IF was inferior to HA in implant-related complication [20.1% vs. 6.0%, relative risk (RR) = 3.18 (1.72, 5.88), P = 0.0002] and reoperation rate [20.1% vs. 6.0%, RR = 3.30 (1.79, 6.08), P = 0.0001]. Hemiarthroplasty had a greater blood loss (mL) [MD = -138.88 (-209.58, -68.18), P = 0.001] and operation duration (min) [MD = -23.27 (-44.95, -1.60), P = 0.04] compared with IF.Conclusion:HA is the preferred technique for nondisplaced FNF if early recovery, higher mobility, and better quality of life are priorities. The choice of fixation should be weighed on an individual patient level.
AB - Objective:To compare internal fixation (IF) versus hemiarthroplasty (HA) for elderly individuals (ie, older than 65 years) with nondisplaced (ie, Garden type I or II) femoral neck fracture (FNF).Data Source:We searched English literature of MEDLINE, PubMed, and Embase from inception to December 4, 2021.Study Selection:Eligibility criteria were randomized controlled trials (RCTs) compared IF versus HA for elderly individuals with nondisplaced FNF. Primary outcomes were Harris hip score (HHS), quality of life per European Quality of Life 5 Dimension (EQ-5D), and mortality. Secondary outcomes were complications, reoperation, intraoperative bleeding, operation duration, and length of hospital stay.Data Extraction:Two authors separately extracted data and assessed the risk of bias of the included studies using Cochrane risk-of-bias tool.Data Synthesis:Three RCTs yielding 400 patients were enrolled, of which 203 (50.7%) underwent IF. Internal fixation was inferior to HA with respect to 6-month HHS [mean difference (MD) = -8.28 (-14.46, -2.10), P = 0.009] and 1-year EQ-5D [MD = -0.07 (-0.14, -0.00), P = 0.04]. The 2 techniques were comparable regarding length of hospital stay (day), HHS at 1 and 2 years, EQ-5D at 2 years, and mortality. IF was inferior to HA in implant-related complication [20.1% vs. 6.0%, relative risk (RR) = 3.18 (1.72, 5.88), P = 0.0002] and reoperation rate [20.1% vs. 6.0%, RR = 3.30 (1.79, 6.08), P = 0.0001]. Hemiarthroplasty had a greater blood loss (mL) [MD = -138.88 (-209.58, -68.18), P = 0.001] and operation duration (min) [MD = -23.27 (-44.95, -1.60), P = 0.04] compared with IF.Conclusion:HA is the preferred technique for nondisplaced FNF if early recovery, higher mobility, and better quality of life are priorities. The choice of fixation should be weighed on an individual patient level.
KW - elderly
KW - femoral neck fracture
KW - hemiarthroplasty
KW - hip fracture
KW - internal fixation
KW - meta-analysis
KW - trauma
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U2 - 10.1097/BOT.0000000000002558
DO - 10.1097/BOT.0000000000002558
M3 - Review article
C2 - 36575572
AN - SCOPUS:85153414521
SN - 0890-5339
VL - 37
SP - E219-E226
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 5
ER -