Key result
Femoral neck system reduces union time by ~1.1 months versus cannulated cancellous screws in young adults.
Why the study?
Implant choice for fixation of femoral neck fractures in young adults is an important factor with limited comparative data between femoral neck system and cannulated cancellous screws.
Does the femoral neck system (FNS) improve outcomes compared to cannulated cancellous (CC) screws in young adults with femoral neck fractures?
Meta-Analysis (n=427)
Does the femoral neck system (FNS) improve outcomes compared to cannulated cancellous (CC) screws in young adults with femoral neck fractures?
Mean Difference: -1.1 (95% CI -1.73–-0.47)
p-value: p=<0.05
FNS provides faster union time and better functional outcomes than CC screws for femoral neck fractures in young adults, despite greater intraoperative blood loss.
FNS may shorten union time and improve function versus CC screws in young adults; leaves open confirmation by RCTs before practice change.
A femoral neck fracture is a very common injury in the elderly. However, its incidence is low among young adults, usually presenting as an emergency. In young adults, implant choice is one of the important factors. This systematic review aims to analyze the femoral neck system (FNS) versus cannulated cancellous (CC) screw for the fixation of femoral neck fractures in young adults through well-defined objectives. A comprehensive search from the electronic database (PubMed, Google Scholar, Web of Science, Cochrane Library) was conducted from the beginning till February 18, 2022. The data regarding study type, authors, year of publication, country, union time, Harris hip score, intraoperative blood loss, operating time, neck shortening, and hospital stay were extracted from the selected articles and analyzed using RevMan 5.4.1 software. For continuous data, e.g., healing time, intraoperative blood loss, operation time, Harris hip score, neck shortening, and hospital stay, the mean difference (MD), either weighted mean difference (WMD) or standardized mean difference (SMD), with a 95% confidence interval (CI) was recorded. A p-value less than 0.05 was taken as statistically significant. The Newcastle Ottawa scale was used for the risk of bias assessment. Six retrospective cohort studies including 427 patients were selected for the meta-analysis. There was significantly less healing time (WMD= -1.10, 95% CI: -1.73 to -0.47), shorter operation duration (WMD=7.70, 95% CI: -0.06 to 15.46), and better Harris hip score (WMD=4.79, 95% CI: 2.12-7.46) in the FNS than CC screw fixation method. However, intraoperative blood loss was significantly less in the CC screw system (WMD=21.27, 95% CI: 8.20-34.35). There was no significant difference between the two approaches in-hospital stay duration and femoral neck shortening. This can be concluded that FNS is better than CC screw fixation for treating neck of femur fractures in adults on the outcome basis of union time, less operation time, and better Harris hip score (HHS) with significant heterogeneity.
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Gupta et al. (2022) conducted a meta-analysis in Femoral neck fracture (n=427). Femoral neck system (FNS) vs. Cannulated cancellous (CC) screw was evaluated on Union time (WMD -1.10, 95% CI -1.73 to -0.47, p=<0.05). The femoral neck system significantly reduced union time by 1.10 months compared to cannulated cancellous screws in young adults with femoral neck fractures.
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