Displaced femoral neck fracture in children: closed versus open reduction: a Meta-analysis

Abstract

Objective To compare open reduction and internal fixation (ORIF) with closed reduction and internal fixation (CRIF) for the treatment of displaced fractures of the femoral neck in children, using a Meta-analysis. Methods Cochrane Library, PubMed Data, CNKI, Chinese Biomedical Database, Wanfang Data and Vip Data were searched for studies on treating displaced fractures of the femoral neck in children with ORIF and CRIF. In addition, hand search was conducted in relevant journals. Time limit for search was set from the beginning till August 2017. After eligible studies were included, a database was established of the demographic and clinical data of the patients included. Software Revman 5.0 was used for heterogeneity test of the quality of the studies included and the pooled relative risk (RR) and 95% confidence interval (CI) were calculated. Results Ten studies were ultimately included involving 309 patients. Of them, 163 were treated by ORIF and 146 by CRIF. The results showed that ORIF led to a significantly higher rate of anatomical reduction [RR=0.33, 95%CI (0.22, 0.49), P<0.05] and a significantly higher good to excellent rate by Ratliff's evaluation [RR=0.73, 95%CI (0.62, 0.85), P< 0.05] than CRIF did; ORIF also led to a significantly lower rate of avascular necrosis[RR=1.93, 95%CI (1.13, 3.31), P<0.05], a significantly lower rate of coxa vara [RR=2.38, 95%CI (1.07, 5.27), P< 0.05] and a significantly lower rate of nonunion [RR=2.72, 95%CI (1.05, 7.04), P<0.05] than CRIF did. Conclusion In the treatment of displaced fractures of the femoral neck in children, ORIF can lead to better reduction, fewer complications and a higher good to excellent rate of functional recovery than CRIF. Key words: Femoral neck fractures; Fracture fixation, internal; Child; Systematic andysis