Outcomes of elderly patients with nondisplaced or minimally displaced femoral neck fractures treated with internal fixation: A systematic review and meta-analysis
| Autor: | John T. Richards, J.C. D'Alleyrand, Archie L. Overmann, Gerard P. Slobogean, Nathan N O'Hara |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Osteoporosis Femoral Neck Fractures Arthroplasty Fracture Fixation Internal 03 medical and health sciences Postoperative Complications 0302 clinical medicine Primary outcome medicine Humans Internal fixation Aged General Environmental Science 030222 orthopedics business.industry 030208 emergency & critical care medicine Evidence-based medicine medicine.disease Surgery Meta-analysis General Earth and Planetary Sciences Risk Adjustment Complication business |
| Zdroj: | Injury. 50:2158-2166 |
| ISSN: | 0020-1383 |
| Popis: | 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. 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. Level of Evidence III |
| Databáze: | OpenAIRE |
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