A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis

Abstract Background Avascular necrosis (AVN) after pediatric femoral neck fracture (PFNF) showed poor prognosis, but its clinical and radiographic characteristics remained unclear. Methods A systematic review and a retrospective study were performed to evaluate the clinical and radiographic characteristics of patients with AVN after PFNF. Results A total of 686 patients with PFNF and 203 patients with AVN from 21 articles were analyzed. Ratliff’s classification was used in 178 patients, with types I, II, and III AVN accounting for 58.4%, 25.3%, and 16.3%, respectively. Ratliff’s assessment was used in 147 patients, of whom 88.4% had an unsatisfactory prognosis. In retrospective study, 115 patients with a mean age of 13.6 ± 2.0 years were included. The mean interval between AVN and PFNF was 13.7 ± 9.5 months. At the time of diagnosis, 59.1% cases were symptomatic and 65.2% progressed to collapsed stage. Fifty (43.5%), 61 (53.0%), and 4 patients (3.5%) were defined as types I, II, and III , respectively, via Ratliff’s classification. Thirteen (11.3%), 40 (34.8%), and 62 patients (53.9%) showed types A/B, C1, and C2 disease, respectively, via the JIC classification. Multivariate analysis demonstrated a strong relation between collapsed stage and symptomatic cases (OR = 6.25, 95% CI = 2.39–16.36) and JIC classification (OR = 3.41, 95% CI = 1.62–7.17). Conclusion AVN after PFNF showed a tendency toward extensive necrotic lesions, presumably resulting in a rapid progression of femoral head collapse. And the symptoms and the JIC classification are other two risk factors of collapse progression.

Download Full-text

Muscle pedicle bone flap transplantation for treating femoral neck fracture in adults: a systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02448-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yipeng Wu ◽

Muguo Song ◽

Guangliang Peng ◽

Yongqing Xu ◽

Yang Li ◽

...

Keyword(s):

Systematic Review ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Avascular Necrosis ◽

Surgical Techniques ◽

Femoral Neck Fractures ◽

Bone Flap ◽

Cochrane Library ◽

Number Of Patients ◽

Neck Fracture

Abstract Background This systematic review was conducted to gather available evidence on the effectiveness of muscle pedicle bone flap transplantation in adult patients with femoral neck fractures. Methods Databases such as PubMed, EMBASE, IEEE, Web of Science, and Cochrane library were searched from their dates of inception until March 2021. Two reviewers independently selected the interventional studies on the assessment of the effectiveness of muscle pedicle bone flap transplantation for femoral neck fractures; data extraction and assessment of the methodological quality as per the Institute of Health Economics quality appraisal checklist were also performed by the reviewers. The effectiveness and complication outcomes were assessed by calculating the average rates. Results Overall, 20 studies with 1022 patients were included in this review. Notably, the methodologic quality of the included studies was typically poor. The average effective rates were as follows: good, 73.4%; fair, 15.4%; and poor, 10.9%. Moreover, the average nonunion rate, average avascular necrosis rate, average collapse rate, and the overall reoperation rate were 9.0%, 6.7%, 4.7%, and 7.3%, respectively. Conclusions This systematic review of heterogeneous studies with varying number of patients and varying surgical techniques indicated that muscle pedicle bone flap transplantation provides promising results with low rates of avascular necrosis and nonunion. Nevertheless, further controlled studies are required to ascertain the effectiveness of muscle pedicle bone flap transplantation in treating femoral neck fracture.

Download Full-text

Avascular necrosis after femoral neck fracture in children and adolescents: poor prognosis and risk factors

International Orthopaedics ◽

10.1007/s00264-021-05210-2 ◽

2021 ◽

Author(s):

Ziqi Li ◽

Zhikun Zhuang ◽

Zhinan Hong ◽

Leilei Chen ◽

Wei He ◽

...

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Children And Adolescents ◽

Femoral Neck Fracture ◽

Avascular Necrosis ◽

Poor Prognosis ◽

Neck Fracture

Download Full-text

Does total hip arthroplasty provide better outcomes than hemiarthroplasty for the femoral neck fracture? A systematic review and meta-analysis

Chinese Journal of Traumatology ◽

10.1016/j.cjtee.2020.09.005 ◽

2020 ◽

Vol 23 (6) ◽

pp. 356-362 ◽

Cited By ~ 1

Author(s):

Wei Peng ◽

Na Bi ◽

Jun Zheng ◽

Na Xi

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Total Hip ◽

Neck Fracture

Download Full-text

The Effect of Type of Femoral Component Fixation on Mortality and Morbidity after Hip Hemiarthroplasty: A Systematic Review and Meta-Analysis

HSS Journal ® ◽

10.1007/s11420-020-09769-1 ◽

2020 ◽

Vol 16 (3) ◽

pp. 222-232

Author(s):

Mohamed Imam ◽

Mohamed Shehata ◽

Mahmoud Morsi ◽

Muhammad Shawqi ◽

Ahmed Elsehili ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Older Patients ◽

Observational Studies ◽

Meta Analysis ◽

Hip Hemiarthroplasty ◽

Uncemented Hemiarthroplasty ◽

Neck Fracture

Abstract Background Hip hemiarthroplasty is a well-established treatment of displaced femoral neck fracture, although debate exists over whether cemented or uncemented fixation is superior. Uncemented prostheses have typically been used in younger, healthier patients and cemented prostheses in older patients with less-stable bone. Also, earlier research has suggested that bone cement has cytotoxic effects and may trigger cardiovascular and respiratory adverse events. Questions/Purposes The aim of this systematic review and meta-analysis was to compare morbidity and mortality rates after cemented and uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven medical databases for randomized clinical trials and observational studies. We compared cemented and uncemented hemiarthroplasty using the Harris Hip Score (HHS), as well as measures of postoperative pain, mortality, and complications. Data were extracted and pooled as risk ratios or standardized mean difference with their corresponding 95% confidence intervals in a meta-analysis model. Results The meta-analysis included 34 studies (12 randomized trials and 22 observational studies), with a total of 42,411 patients. In the pooled estimate, cemented hemiarthroplasty was associated with less risk of postoperative pain than uncemented hemiarthroplasty. There were no significant differences between groups regarding HHS or rates of postoperative mortality, pulmonary embolism, cardiac arrest, myocardial infarction, acute cardiac arrhythmia, or deep venous thrombosis. Conclusions While we found that cemented hemiarthroplasty results in less postoperative pain than uncemented hemiarthroplasty in older patients with femoral neck fracture, the lack of significant differences in functional hip scores, mortality, and complications was surprising. Further high-level research is needed.

Download Full-text