Outcomes of elderly patients with nondisplaced or minimally displaced femoral neck fractures treated with internal fixation: A systematic review and meta-analysis. Issue 12 (December 2019)

• Record Type: Journal Article
• Authors: Overmann, A.L.; Richards, J.T.; O'Hara, N.N.; D'Alleyrand, J.C.; Slobogean, G.P.
• Is Part Of: Injury. Volume 50:Issue 12(2019)
• Page Start: 2158
• Page End: 2166
• Publication Date: 2019-12
• Subjects: Elderly -- Nondisplaced -- Minimally displaced -- Femoral neck fracture -- Internal fixation -- Osteoporosis -- Fracture; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.09.039
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: This systematic review and meta-analysis of nondisplaced hip fractures treated with internal fixation in elderly patients included 27 studies and 21, 155 patients. The meta-analysis determined a 15% risk of one-year mortality and a 14% risk of reoperation within one-year of an internal fixation treatment of a nondisplaced hip fracture in elderly patients. Only three studies compared internal fixation to arthroplasty in this review, providing little evidence for arthroplasty as an alternative treatment for internal fixation in this population. Abstract: Background: Internal fixation remains the treatment of choice for non-displaced femoral neck fractures in elderly patients. Improved outcomes with arthroplasty following displaced femoral neck fractures may indicate that outcomes of non-displaced patterns should be reexamined. The aim of our study was to conduct a systematic review of the orthopaedic literature to determine the outcomes of internal fixation for the treatment of non-displaced and minimally displaced femoral neck fractures in elderly patients. Methods: Relevant articles were identified using PubMed, Embase, and CENTRAL databases. Manuscripts were included if they contained (1) patients 60 years or older with (2) nondisplaced or minimally displaced (Garden I or II) femoral neck fractures (3) treated with internal fixation (4) separately reported outcomes in this patient population. The primary outcome was reoperation. Secondary outcomes included mortality, patient-reported outcomes, length of hospitalization, infection, and transfusions. Fixed and random effects modeling was used to determine pooled estimates of the outcomes. Results: Twenty-seven studies were identified with a total of 21, 155 patients, all of which were treated with internal fixation. The pooled risk of reoperation was 14.1% (95% CI: 10.6–18.2). The risk of one-year mortality was 14.6% (95% CI: 11.5–18.2) based on the reporting in 15 studies. Conclusions: The risk of reoperation and mortality following the treatment of nondisplaced femoral neck fractures in the elderly with internal fixation exceeds 14%. This complication profile may be unacceptably high. Arthroplasty may offer improved short-term functional outcomes and a reduced risk of reoperation. However, there is currently little evidence to consider this treatment to be an alternative to internal fixation.