Key result
Internal fixation was associated with the highest incidence of reoperation (OR 13.39 vs unipolar cemented hemiarthroplasty), while unipolar cemented hemiarthroplasty provided the lowest reoperation incidence among 7 procedures.
Why the study?
Does the choice of surgical intervention reduce reoperation, mortality, dislocation, and infection in elderly patients with displaced intracapsular femoral neck fractures?
Meta-Analysis (n=6,141)
Yes
Does the choice of surgical intervention reduce reoperation, mortality, dislocation, and infection in elderly patients with displaced intracapsular femoral neck fractures?
Odds Ratio: 13.39 (95% CI 6.21–26.06)
In elderly patients with displaced intracapsular femoral neck fractures, unipolar cemented hemiarthroplasty may provide the lowest reoperation incidence, while internal fixation has the highest.
Unipolar cemented hemiarthroplasty should be prioritized to minimize reoperations; extends network evidence across seven procedures versus internal fixation.
Displaced intracapsular femoral neck (AO type 31 B2/3) fractures have various treatments, including internal fixation (IF), unipolar uncemented hemiarthroplasty (HA), bipolar uncemented HA, unipolar cemented HA, bipolar cemented HA, uncemented total hip replacement (THR), and cemented THR. Systematic literature retrieval was performed from the databases to compare them in a network meta-analysis. Forty studies (85 arms) containing 6141 patients were included. Overall, our network meta-analysis rank the orders of 7 procedures in reoperation, mortality, dislocation and infection, which indicates that IF may provide the highest reoperation incidence, unipolar cemented HA may provide the lowest reoperation incidence; uncemented THR contributes the highest dislocation incidence; and bipolar uncemented HA provides the lowest infection incidence. No differences in mortality were observed among the treatments. This conclusion is indirect; higher-quality direct comparisons are required.
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Zhang et al. (2017) conducted a meta-analysis in Displaced intracapsular femoral neck fractures (n=6,141). Surgical procedures (internal fixation, hemiarthroplasty, total hip replacement) vs. Network comparison among 7 procedures was evaluated on Reoperation (OR 13.39, 95% CI 6.21 to 26.06). Internal fixation was associated with the highest incidence of reoperation (OR 13.39 vs unipolar cemented hemiarthroplasty), while unipolar cemented hemiarthroplasty provided the lowest reoperation incidence among 7 procedures.
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