What is the best method of fixation for minimally displaced subcapital neck of femur fractures? A systematic review
Background. Femoral neck fractures are a common cause of morbidity and mortality in the community. Minimally displaced subcapital necks of femoral fractures are usually managed with internal fixation, although there is debate as to which method is superior. This systematic review aimed to compare th...
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| Veröffentlicht in: | Journal of orthopaedics 2023-11, Vol.45, p.54-60 |
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| creator | Kumar, Joash Symonds, Tristan Quinn, Jonathan Walsh, Tom Platt, Simon |
| description | Background.
Femoral neck fractures are a common cause of morbidity and mortality in the community. Minimally displaced subcapital necks of femoral fractures are usually managed with internal fixation, although there is debate as to which method is superior. This systematic review aimed to compare the outcomes of different fixation methods in the management of this common fracture.
Methods.
This systematic review was conducted in accordance with PRISMA statement guidelines. The databases searched were MEDLINE (Ovid), Cochrane Central Register of Controlled Trials, and EMBASE (Ovid). The study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scale, and relevant data were extracted and synthesised.
Results.
Nine articles met the inclusion criteria. A total of 819 patients were included in this study. Eight of the nine studies were case series, and one was a randomised control trial. The mean risk of bias was 7.4/9 for non-randomised articles. The fixation methods used in the included studies were dynamic hip screw (DHS), cannulated screws, Smith-Peterson nail, hooknail, Moore's pins, and Knowle's pins. DHS was found to be a superior method of fixation and was supported by a clinical trial. It has high rates of union (99 %), low rates of avascular necrosis ( |
| doi_str_mv | 10.1016/j.jor.2023.09.015 |
| format | Article |
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Femoral neck fractures are a common cause of morbidity and mortality in the community. Minimally displaced subcapital necks of femoral fractures are usually managed with internal fixation, although there is debate as to which method is superior. This systematic review aimed to compare the outcomes of different fixation methods in the management of this common fracture.
Methods.
This systematic review was conducted in accordance with PRISMA statement guidelines. The databases searched were MEDLINE (Ovid), Cochrane Central Register of Controlled Trials, and EMBASE (Ovid). The study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scale, and relevant data were extracted and synthesised.
Results.
Nine articles met the inclusion criteria. A total of 819 patients were included in this study. Eight of the nine studies were case series, and one was a randomised control trial. The mean risk of bias was 7.4/9 for non-randomised articles. The fixation methods used in the included studies were dynamic hip screw (DHS), cannulated screws, Smith-Peterson nail, hooknail, Moore's pins, and Knowle's pins. DHS was found to be a superior method of fixation and was supported by a clinical trial. It has high rates of union (99 %), low rates of avascular necrosis (<1 %), and low rates of fixation failure (<1 %).
Conclusions.
Based on the available data, DHS appears to be the superior method of fixation for the minimally displaced subcapital neck of femoral fractures. Given the general low level of evidence currently available, additional clinical trials are needed in this area.</description><identifier>ISSN: 0972-978X</identifier><identifier>EISSN: 0972-978X</identifier><identifier>DOI: 10.1016/j.jor.2023.09.015</identifier><identifier>PMID: 37854276</identifier><language>eng</language><publisher>India: Elsevier B.V</publisher><subject>Fracture ; Minimally displaced ; Neck of femur ; Open reduction internal fixation ; Review article ; Subcapital</subject><ispartof>Journal of orthopaedics, 2023-11, Vol.45, p.54-60</ispartof><rights>2023</rights><rights>2023 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.</rights><rights>2023 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c452t-27dc81453f123abf23b54db251c5a7bee4aa32e48b14384e9025a8d9c08822293</citedby><cites>FETCH-LOGICAL-c452t-27dc81453f123abf23b54db251c5a7bee4aa32e48b14384e9025a8d9c08822293</cites><orcidid>0000-0002-2391-7749 ; 0000-0002-3925-2075 ; 0000-0003-0374-2205 ; 0000-0002-3559-5230</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579867/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579867/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37854276$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kumar, Joash</creatorcontrib><creatorcontrib>Symonds, Tristan</creatorcontrib><creatorcontrib>Quinn, Jonathan</creatorcontrib><creatorcontrib>Walsh, Tom</creatorcontrib><creatorcontrib>Platt, Simon</creatorcontrib><title>What is the best method of fixation for minimally displaced subcapital neck of femur fractures? A systematic review</title><title>Journal of orthopaedics</title><addtitle>J Orthop</addtitle><description>Background.
Femoral neck fractures are a common cause of morbidity and mortality in the community. Minimally displaced subcapital necks of femoral fractures are usually managed with internal fixation, although there is debate as to which method is superior. This systematic review aimed to compare the outcomes of different fixation methods in the management of this common fracture.
Methods.
This systematic review was conducted in accordance with PRISMA statement guidelines. The databases searched were MEDLINE (Ovid), Cochrane Central Register of Controlled Trials, and EMBASE (Ovid). The study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scale, and relevant data were extracted and synthesised.
Results.
Nine articles met the inclusion criteria. A total of 819 patients were included in this study. Eight of the nine studies were case series, and one was a randomised control trial. The mean risk of bias was 7.4/9 for non-randomised articles. The fixation methods used in the included studies were dynamic hip screw (DHS), cannulated screws, Smith-Peterson nail, hooknail, Moore's pins, and Knowle's pins. DHS was found to be a superior method of fixation and was supported by a clinical trial. It has high rates of union (99 %), low rates of avascular necrosis (<1 %), and low rates of fixation failure (<1 %).
Conclusions.
Based on the available data, DHS appears to be the superior method of fixation for the minimally displaced subcapital neck of femoral fractures. Given the general low level of evidence currently available, additional clinical trials are needed in this area.</description><subject>Fracture</subject><subject>Minimally displaced</subject><subject>Neck of femur</subject><subject>Open reduction internal fixation</subject><subject>Review article</subject><subject>Subcapital</subject><issn>0972-978X</issn><issn>0972-978X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kTtvFDEUhS0EIi9-AA1ySbMTP9e2KKIogiRSJBpQ0lkezx3Wy8x4sT2B_ffxZkMUGipb8jnnXp8PofeUNJTQ5em6WcfUMMJ4Q0xDqHyFDolRbGGUvnv94n6AjnJeE8KZXPK36IArLQVTy0OUb1eu4JBxWQFuIRc8QlnFDsce9-GPKyFOuI8Jj2EKoxuGLe5C3gzOQ4fz3Hq3CcUNeAL_89ED45xwn5wvc4J8hs9x3uYCY03yOMF9gN8n6E3vhgzvns5j9P3L528XV4ubr5fXF-c3Cy8kKwumOq-pkLynjLu2Z7yVomuZpF461QII5zgDoVsquBZgCJNOd8YTrRljhh-js33uZm5H6DxMJbnBblL9SNra6IL992UKK_sj3ltKpDJ6qWrCx6eEFH_NtR07huxhGNwEcc6WaWUEEVTthtG91KeYc4L-eQ4ldkfLrm2lZXe0LDG20qqeDy8XfHb8xVMFn_YCqDXV6pLNPsBUuw8JfLFdDP-JfwCJyagt</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Kumar, Joash</creator><creator>Symonds, Tristan</creator><creator>Quinn, Jonathan</creator><creator>Walsh, Tom</creator><creator>Platt, Simon</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2391-7749</orcidid><orcidid>https://orcid.org/0000-0002-3925-2075</orcidid><orcidid>https://orcid.org/0000-0003-0374-2205</orcidid><orcidid>https://orcid.org/0000-0002-3559-5230</orcidid></search><sort><creationdate>20231101</creationdate><title>What is the best method of fixation for minimally displaced subcapital neck of femur fractures? A systematic review</title><author>Kumar, Joash ; Symonds, Tristan ; Quinn, Jonathan ; Walsh, Tom ; Platt, Simon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c452t-27dc81453f123abf23b54db251c5a7bee4aa32e48b14384e9025a8d9c08822293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Fracture</topic><topic>Minimally displaced</topic><topic>Neck of femur</topic><topic>Open reduction internal fixation</topic><topic>Review article</topic><topic>Subcapital</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kumar, Joash</creatorcontrib><creatorcontrib>Symonds, Tristan</creatorcontrib><creatorcontrib>Quinn, Jonathan</creatorcontrib><creatorcontrib>Walsh, Tom</creatorcontrib><creatorcontrib>Platt, Simon</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kumar, Joash</au><au>Symonds, Tristan</au><au>Quinn, Jonathan</au><au>Walsh, Tom</au><au>Platt, Simon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>What is the best method of fixation for minimally displaced subcapital neck of femur fractures? A systematic review</atitle><jtitle>Journal of orthopaedics</jtitle><addtitle>J Orthop</addtitle><date>2023-11-01</date><risdate>2023</risdate><volume>45</volume><spage>54</spage><epage>60</epage><pages>54-60</pages><issn>0972-978X</issn><eissn>0972-978X</eissn><abstract>Background.
Femoral neck fractures are a common cause of morbidity and mortality in the community. Minimally displaced subcapital necks of femoral fractures are usually managed with internal fixation, although there is debate as to which method is superior. This systematic review aimed to compare the outcomes of different fixation methods in the management of this common fracture.
Methods.
This systematic review was conducted in accordance with PRISMA statement guidelines. The databases searched were MEDLINE (Ovid), Cochrane Central Register of Controlled Trials, and EMBASE (Ovid). The study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scale, and relevant data were extracted and synthesised.
Results.
Nine articles met the inclusion criteria. A total of 819 patients were included in this study. Eight of the nine studies were case series, and one was a randomised control trial. The mean risk of bias was 7.4/9 for non-randomised articles. The fixation methods used in the included studies were dynamic hip screw (DHS), cannulated screws, Smith-Peterson nail, hooknail, Moore's pins, and Knowle's pins. DHS was found to be a superior method of fixation and was supported by a clinical trial. It has high rates of union (99 %), low rates of avascular necrosis (<1 %), and low rates of fixation failure (<1 %).
Conclusions.
Based on the available data, DHS appears to be the superior method of fixation for the minimally displaced subcapital neck of femoral fractures. Given the general low level of evidence currently available, additional clinical trials are needed in this area.</abstract><cop>India</cop><pub>Elsevier B.V</pub><pmid>37854276</pmid><doi>10.1016/j.jor.2023.09.015</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-2391-7749</orcidid><orcidid>https://orcid.org/0000-0002-3925-2075</orcidid><orcidid>https://orcid.org/0000-0003-0374-2205</orcidid><orcidid>https://orcid.org/0000-0002-3559-5230</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Fracture Minimally displaced Neck of femur Open reduction internal fixation Review article Subcapital |
| title | What is the best method of fixation for minimally displaced subcapital neck of femur fractures? A systematic review |
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