Outcomes of elderly patients with nondisplaced or minimally displaced femoral neck fractures treated with internal fixation: A systematic review and meta-analysis

A L Overmann; J T Richards; N N O'Hara; J C D'Alleyrand; G P Slobogean

doi:10.1016/j.injury.2019.09.039

Outcomes of elderly patients with nondisplaced or minimally displaced femoral neck fractures treated with internal fixation: A systematic review and meta-analysis

Injury. 2019 Dec;50(12):2158-2166. doi: 10.1016/j.injury.2019.09.039. Epub 2019 Oct 1.

Authors

A L Overmann¹, J T Richards¹, N N O'Hara², J C D'Alleyrand³, G P Slobogean⁴

Affiliations

¹ Division of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda MD, USA.
² Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 110 South Paca St., Baltimore, MD 21201, USA.
³ Division of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda MD, USA; Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 110 South Paca St., Baltimore, MD 21201, USA.
⁴ Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 110 South Paca St., Baltimore, MD 21201, USA. Electronic address: gslobogean@som.umaryland.edu.

PMID: 31623902
DOI: 10.1016/j.injury.2019.09.039

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.

Keywords: Elderly; Femoral neck fracture; Fracture; Internal fixation; Minimally displaced; Nondisplaced; Osteoporosis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Aged
Arthroplasty / adverse effects
Arthroplasty / methods
Femoral Neck Fractures / surgery*
Fracture Fixation, Internal* / adverse effects
Fracture Fixation, Internal* / methods
Humans
Postoperative Complications / prevention & control*
Risk Adjustment / methods