Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2022; 10(31): 11454-11465
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11454
Efficacy of the femoral neck system in femoral neck fracture treatment in adults: A systematic review and meta-analysis
Zhi-Fang Wu, Zi-Heng Luo, Liu-Chao Hu, Yi-Wen Luo
Zhi-Fang Wu, Zi-Heng Luo, Liu-Chao Hu, Yi-Wen Luo, Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), Guangzhou 510378, Guangdong Province, China
Author contributions: Wu ZF and Luo ZH were responsible for the data management and formal analysis; Wu ZF and Hu LC were responsible for the manuscript design, concept and methodology; Luo ZH and Hu LC searched the literature; Wu ZF wrote the original draft; Luo YW was responsible for manuscript writing, reviewing and editing.
Supported by Guangdong Provincial Administration of Chinese Medicine Research Project, No. 20201168; and the Project of Foundations of the Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, No. GYH202101-02.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Wen Luo, PhD, Chief Doctor, Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), No. 261 Longxi Road, Liwan District, Guangzhou 510378, Guangdong Province, China. gzzyydxlyw@126.com
Received: April 25, 2022
Peer-review started: April 25, 2022
First decision: June 27, 2022
Revised: July 19, 2022
Accepted: October 9, 2022
Article in press: October 9, 2022
Published online: November 6, 2022
Processing time: 184 Days and 12.3 Hours
Abstract
BACKGROUND

Controversy remains around the available choices for the internal fixation of a femoral neck fracture. The femoral neck system (FNS) was developed in 2018 and has been widely applied since then as it can provide rigid fixation stability with less damage to the bone mass around the fracture. However, no systematic reviews and meta-analyses have investigated the efficacy of the FNS in comparison with that of traditional internal fixation in the treatment of femoral fractures.

AIM

To assess the efficacy of the FNS in comparison with that of cannulated compression screws (CCS) in the treatment of femoral fractures through systematic review and meta-analysis.

METHODS

Five electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang) were searched from the earliest publication date to December 31, 2021. Reference Citation Analysis (https://www.referencecitationanalysis.com/) was used to check the results and further analyze the related articles. Controlled trials were included if the FNS was applied for the femoral neck fracture in adults and if it was compared with CCS for the achievement of internal fixation. The measurement outcomes included the required operation time, observed patient’s blood loss, extent of fracture healing, patient’s Harris Hip score (HHS) at the last follow-up, and records of any complications (such as failure of internal fixation, femoral neck shortness, avascular necrosis of the femoral head, and delayed union or nonunion).

RESULTS

Ten retrospective controlled studies (involving 711 participants) were included in this meta-analysis. The meta-analysis showed that compared with CCS, use of the FNS could not decrease the operation time [standardized mean difference (SMD): -0.38, 95% confidence interval (CI): -0.98 to 0.22, P = 0.21, I2 = 93%), but it could increase the intraoperative blood loss (SMD: 0.59, 95%CI: 0.15 to 1.03, P = 0.009, I2 = 81%). The pooled results also showed that compared with CCS, the FNS could better promote fracture healing (SMD: -0.97, 95%CI: -1.65 to -0.30, P = 0.005, I2 = 91%), improve the HHS at the last follow-up (SMD: 0.76, 95%CI: 0.31 to 1.21, P = 0.0009, I2 = 84%), and reduce the chances of developing femoral neck shortness (OR: 0.29, 95%CI: 0.14 to 0.61, P = 0.001, I2 = 0%) and delayed union or nonunion (OR: 0.47, 95%CI: 0.30 to 0.73, P = 0.001; I2 = 0%) in adult patients with femoral neck fractures. However, there was no statistically significant difference between the FNS and CCS in terms of failure of internal fixation (OR: 0.49, 95%CI: 0.23 to 1.06, P = 0.07, I2 = 0%) and avascular necrosis of the femoral head (OR: 0.46, 95%CI: 0.20 to 1.10, P = 0.08, I2 = 0%).

CONCLUSION

Compared with CCS, the FNS could decrease the chances of developing femoral neck shortness and delayed union or nonunion in adults with femoral neck fractures. Simultaneously, it could accelerate fracture healing and improve the HHS in these patients.

Keywords: Femoral neck fracture; Internal fixators; Treatment outcome; Systematic review; Meta-analysis

Core Tip: This study aimed to investigate the efficacy of the femoral neck system (FNS) in comparison with cannulated compression screws (CCS) in the treatment of femoral neck fractures in adults. A total of 10 studies involving 711 participants were included. This study revealed that compared with CCS, the FNS could decrease the chances of developing short femoral neck and delayed union or nonunion as well as accelerate fracture healing and improve the Harris Hip score at the last follow-up in adult patients with femoral neck fractures. These results could help in the selection of the most appropriate treatment for patients with femoral neck fractures.