Dynamic hip screws versus cannulated screws for femoral neck fractures: a systematic review and meta-analysis
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(2020) 15:352
SYSTEMATIC REVIEW
Open Access
Dynamic hip screws versus cannulated screws for femoral neck fractures: a systematic review and meta-analysis Lang Li1, Xue Zhao2, Xiaodong Yang1, Xueyang Tang1 and Ming Liu3*
Abstract Objective: Dynamic hip screw (DHS) and cannulated screws (CS) are widely used for femoral neck fractures. However, there is no definite result as to which surgical method bring less complications. We performed this study to compare the complication (mortality, non-union, avascular necrosis (AVN), and revision) of DHS and CS for the treatment of femoral neck fractures patients. Methods: We searched Pubmed, Ovid, Cochrane Central Register of Controlled Trials, and other relevant studies related the comparison of DHS versus CS for femoral neck fractures from inception to Jan 7, 2020. The quality of the included randomized controlled trials (RCTs) and retrospective studies were assessed using the Cochrane Collaboration tool and Newcastle-Ottawa (NOS), respectively. The meta-analysis was performed by the RevMan 5.2 software. Results: Nine RCTs and seven retrospective cohort studies were included for meta-analysis. CS was found to be superior to DHS with respect to AVN rate (OR 1.47; 95% CI 1.08–1.99; p = 0.01, I2 = 0%). There were no significant between-group differences with respect to mortality, non-union, and revision (p > 0.05). Conclusion: DHS and CS have similar complication including mortality, revision rate, and non-union, but CS has superior to DHS on ANV. However, further studies are required to provide more robust evidence owing to some limitations. Keywords: Meta-analysis, Dynamic hip screw, Cannulated screws, Femoral neck fractures
Introduction Femoral neck fractures are common fractures in the orthopedics department, and incidence of femoral neck fracture increased with the increase of population ages and traffic accidents. Previous study reported that for young adult patients, the incidence of femoral neck fractures amounted to 0.04%. However, the incidence for older patients is increase to 0.28~0.64% [1, 2]. In the past, due to the limited treatment methods for femoral * Correspondence: [email protected] 3 Department of Orthopedics, West China Hospital, Sichuan University, #37, Guo Xue Xiang, Chengdu 610041, Sichuan, People’s Republic of China Full list of author information is available at the end of the article
neck fracture, it has been considered as “unresolved fracture” [3]. Previous studies reported that femoral neck fractures are associated with complications such as avascular necrosis (AVN), non-union, implant failure/revision, and even death [4, 5]. There are many options to treat femoral neck fracture. Previous studies reported that femoral neck fractures with following surgery are associated implant failure [6, 7]. Multiple cannulated screws (CS) and dynamic hip screw (DHS) are widely used for non-displaced or young patients. CS has better biomedical properties such as anti-rotation and less invasive, which was widely used in non-displaced intracapsular fractures
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