John T Richards1, Archie L Overmann1, Nathan N O'Hara2, Jean-Claude D'Alleyrand1, Gerard P Slobogean2. 1. Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD; and. 2. Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
Abstract
OBJECTIVE: To compare the outcomes of elderly patients with nondisplaced and minimally displaced femoral neck fractures treated with internal fixation versus arthroplasty. DATA SOURCES: A comprehensive search of the MEDLINE, Embase, and central databases was conducted through June 25, 2019. STUDY SELECTION: Studies were included if the sample population was (1) 60 years of age or older, (2) had nondisplaced or minimally displaced (Garden I or II) femoral neck fractures, and (3) if the study compared internal fixation versus arthroplasty. Only full-text English manuscripts were included. The primary outcome was reoperation. Secondary outcomes included mortality, patient-reported outcomes, length of hospital stay, infection, and blood transfusions. DATA EXTRACTION: Two authors independently extracted data from the included studies. Each study was independently evaluated for quality using the Cochrane risk of bias assessment. DATA SYNTHESIS: Of the 1597 identified articles, 4 manuscripts met the eligibility criteria with a total of 579 patients (236 treated with hemiarthroplasty and 343 treated with internal fixation). Patients treated with arthroplasty had a significantly lower risk of reoperation when compared with those treated with internal fixation [relative risk: 0.30 (95% CI, 0.16-0.55, P < 0.01)]. There was no significant difference detected in 1-year mortality risk between the 2 treatment groups. CONCLUSIONS: In elderly patients with nondisplaced and minimally displaced femoral neck fractures, treatment with hemiarthroplasty may reduce the relative risk of reoperation by 70% when compared with internal fixation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVE: To compare the outcomes of elderly patients with nondisplaced and minimally displaced femoral neck fractures treated with internal fixation versus arthroplasty. DATA SOURCES: A comprehensive search of the MEDLINE, Embase, and central databases was conducted through June 25, 2019. STUDY SELECTION: Studies were included if the sample population was (1) 60 years of age or older, (2) had nondisplaced or minimally displaced (Garden I or II) femoral neck fractures, and (3) if the study compared internal fixation versus arthroplasty. Only full-text English manuscripts were included. The primary outcome was reoperation. Secondary outcomes included mortality, patient-reported outcomes, length of hospital stay, infection, and blood transfusions. DATA EXTRACTION: Two authors independently extracted data from the included studies. Each study was independently evaluated for quality using the Cochrane risk of bias assessment. DATA SYNTHESIS: Of the 1597 identified articles, 4 manuscripts met the eligibility criteria with a total of 579 patients (236 treated with hemiarthroplasty and 343 treated with internal fixation). Patients treated with arthroplasty had a significantly lower risk of reoperation when compared with those treated with internal fixation [relative risk: 0.30 (95% CI, 0.16-0.55, P < 0.01)]. There was no significant difference detected in 1-year mortality risk between the 2 treatment groups. CONCLUSIONS: In elderly patients with nondisplaced and minimally displaced femoral neck fractures, treatment with hemiarthroplasty may reduce the relative risk of reoperation by 70% when compared with internal fixation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Authors: Joseph Boktor; Abdul Badurudeen; Manhal Rijab Agha; Peter M Lewis; Gareth Roberts; Robert Hills; Anthony Johansen; Simon White Journal: Bone Jt Open Date: 2022-03
Authors: Jonas Sundkvist; Anders Brüggeman; Arkan Sayed-Noor; Michael Möller; Olof Wolf; Sebastian Mukka Journal: J Orthop Surg Res Date: 2021-09-15 Impact factor: 2.359