Outcomes of nondisplaced intracapsular femoral neck fractures with internal screw fixation in elderly patients: a systematic review

2017 ◽  
Vol 28 (1) ◽  
pp. 18-28 ◽  
Author(s):  
Ignacio J. Oñativia ◽  
Pablo A.I. Slulittel ◽  
Fernando Diaz Dilernia ◽  
Juan M. Gonzales Viezcas ◽  
Valeria Vietto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
The Elderly ◽  
Reoperation Rate ◽  
Femoral Neck Fractures ◽  
Displaced Femoral Neck Fractures

Introduction: Although the preferred treatment for displaced femoral neck fractures in the elderly is hip arthroplasty, the treatment for impacted or undisplaced femoral neck fractures (UFNF) is still a subject of controversy. Our purpose was to systematically review studies of elderly patients with UFNF treated with internal fixation using screws: (i) what is the reported mortality; (ii) what is the reoperation rate; (iii) what are the clinical and radiological outcomes; and (iv) what is the methodological quality of the included studies? Methods: This systematic review was performed through a search of PubMed and the Cochrane database using a structured search algorithm including studies enrolling patients older than 60 years old, with UFNF treated with internal fixation using screws. Our literature search returned 950 studies and 11 were selected for final abstraction. Results: 6 studies reported mortality rate. At 1-year follow-up mortality was reported by 3 studies: 18.8%; 22%, and 19%. At 5 years, 1 study reported mortality rate of 42%. Overall reoperation rate was reported by 9 studies and ranged from 8%-19%, while conversion to hip arthroplasty was performed in the range between 8% and 16% according to 6 studies. Conclusions: Internal fixation with cannulated screws for UFNF in the elderly is a valuable option, although it has substantial reoperation and mortality rates. Further prospective high-quality, randomised controlled trials are required to establish the optimal approach for the treatment of UFNF.

216 Fix or Replace: Is Internal Fixation Still A Viable Option in The Elderly with Un-Displaced Intracapsular Femoral Neck Fractures?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Morris ◽  
A Krishna ◽  
H Hamid ◽  
M Chawda ◽  
H Mumtaz
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Revision Surgery ◽  
Retrospective Review ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Cannulated Screws ◽  
Viable Option ◽  
Displaced Femoral Neck Fractures

Abstract Aim The treatment of impacted or un-displaced femoral neck fractures in the elderly osteoporotic patient is still largely debated, with arthroplasty versus internal fixation two surgical options1. Our aim was to retrospectively review patients over the age of 80 with un-displaced intracapsular hip fractures who had undergone internal fixation and assess their rate of mortality and revision surgery. Method We conducted a retrospective review of all patients with femoral neck fractures over a 4-year period between January 2015 to December 2018. We refined this to only patients over the age of 80 with un-displaced intracapsular femoral neck fractures fixed with cannulated screws. We noted their mental and mobility status, their follow-up attendance over 3 years, their mortality and rate of revision surgery. Results There were a total of 1232 femoral neck fractures in a 4-year period. Of these, 37 were >80 with un-displaced intracapsular femoral neck fractures, with 23 fixed with cannulated screws and 14 with a Dynamic Hip Screw. Mean age – 85, M:F (1:4.75). All patients were either Garden Classification Type I or II. 4% had cognitive impairment. All patients were independently mobile. 83% were followed up for 3 years, with 1 patient (4%) undergoing revision surgery 3 years following cannulated screw fixation. The 30-day mortality rate was 5%. Conclusions The treatment choice for un-displaced intracapsular femoral neck fractures in the elderly remains debateable. Our retrospective review shows that the rate of re-operation is low in patients who have undergone fixation with cannulated screws and so this remains a viable option.

scholarly journals Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials

2012 ◽  
Vol 36 (8) ◽  
pp. 1549-1560 ◽  
Author(s):  
Paul T. P. W. Burgers ◽  
Arnoud R. Van Geene ◽  
Michel P. J. Van den Bekerom ◽  
Esther M. M. Van Lieshout ◽  
Bastiaan Blom ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Femoral Neck Fractures ◽  
Total Hip ◽  
Healthy Elderly ◽  
Displaced Femoral Neck Fractures

scholarly journals Outcomes of internal fixation versus hemiarthroplasty for elderly patients with an undisplaced femoral neck fracture: a systematic review and meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hsuan-Hsiao Ma ◽  
Te-Feng Arthur Chou ◽  
Shang-Wen Tsai ◽  
Cheng-Fong Chen ◽  
Po-Kuei Wu ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Reoperation Rate ◽  
Fixation Group ◽  
Neck Fracture

Abstract Background Although internal fixation has been the main treatment option for elderly patients with an undisplaced femoral neck fracture, it is associated with a high reoperation rate. Some surgeons have discussed the use of hemiarthroplasty, but there is limited literature comparing these two treatment modalities. In this study, we compared the perioperative results of hemiarthroplasty with internal fixation for undisplaced femoral neck fractures. Methods We performed a comprehensive review of literatures on PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials and comparative observational studies. Of the 441 studies initially identified, 3 met all inclusion criteria. Two reviewers independently graded study quality and abstracted relevant data including reoperation rate, mortality rate, Harris Hip Score (HHS), length of hospital stay, and operation duration. Results Our results revealed that hemiarthroplasty was associated with a lower reoperation rate than the internal fixation group (OR 4.489; 95% CI 2.030 to 9.927). Mortality rate at postoperative 1 month and 1 year and HHS at postoperative 1 year and 2 years were not different. Length of hospital stay (SMD − 0.800, 95% CI − 1.011 to − 0.589) and operation duration (SMD − 2.497, 95% CI − 2.801 to − 2.193) were shorter in the internal fixation group. Conclusions Compared with the internal fixation group, patients that underwent hemiarthroplasty had a lower reoperation rate and an equivalent overall mortality rate. Our meta-analysis suggests that hemiarthroplasty might be a better treatment choice than internal fixation in treating elderly patients with an undisplaced femoral neck fracture.

scholarly journals Comparing total hip arthroplasty and hemiarthroplasty for the treatment of displaced femoral neck fracture in the active elderly over 75 years old: a systematic review and meta-analysis of randomised control trials

2019 ◽  
Author(s):  
Liu Yijun ◽  
Chen Xiaokun ◽  
Zhang Peixun ◽  
Jiang Baoguo
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Hip Arthroplasty ◽  
Femoral Neck Fractures ◽  
Cochrane Library ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
Operation Rate

Abstract Background: Displaced femoral neck fractures (DFNF) are increasingly common in elderly patients. Repair of DFNF can be completed using two methods, hemiarthroplasty (HA) or total hip Arthroplasty (THA). However, there is much controversy regarding whether HA or THA is superior in active elderly patients over 75 years old. Methods: We conducted the literature search by searching PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, and Web of Science from the inception dates to June 1, 2019. Randomised controlled trials (RCT) were included according to the inclusion and exclusion criteria. Included studies were analysed according to Cochrane review methods. Results: Nine studies met the inclusion criteria totalling 631 participants (301 THA and 330 HA）. Four of the studies conducted were identical to a previous study but look at different follow up measures. The analysis of previously collected data revealed that the THA group had a lower erosion rate, higher total pain and function HHS, and higher EQ-5Dindex. The re-operation rate was significantly lower in the THA group after five years of follow up after adding the patients with painful symptoms to the group of patients revised. However, THA had longer operative time and a higher dislocation rate in the first three years compared to the HA procedure. Moreover, there was an insignificant difference in mortality rate, general complications, wound infection, duration of hospital stay, and VTE prevalence among the two procedures. Conclusions: THA may be a preferred management option for active elderly patients over 75 years old, after careful evaluation of patients’ general condition and tolerance of surgery. Strict management and follow up protocols should be followed to prevent dislocation within the first three years following a THA. Trial registration: This study was registered at the International Prospective Register of Systematic Reviews (CRD42019139135). The date of registration is 16-06-2019. Keywords: displaced femoral neck fractures; total hip arthroplasty; hemiarthroplasty;

Total Hip Arthroplasty After In Situ Fixation of Minimally Displaced Femoral Neck Fractures in Elderly Patients

2018 ◽  
Vol 33 (1) ◽  
pp. 144-148 ◽  
Author(s):  
Nicholas M. Hernandez ◽  
Brian P. Chalmers ◽  
Kevin I. Perry ◽  
Daniel J. Berry ◽  
Brandon J. Yuan ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Hip Arthroplasty ◽  
Femoral Neck Fractures ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
In Situ Fixation
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