Abstract
BackgroundAlthough the risk factors associated with osteonecrosis of femoral head (ONFH) after internal fixation of femoral neck fracture (IFFNF) have been frequently reported, the results remain controversial. Therefore, its related risk factors were systematically evaluated and meta-classified in this study.MethodsLiterature on risk factors of ONFH caused by IFFNF was retrieved in PubMed, Embase and Cochrane Library due June 2019. Review Manager 5.3 software was applied to data synthesis, and Stata 13.0 software was adopted for analyses of publication bias and sensitivity.ResultsA total of 17 case-control studies with 2065 patients were included. The risk of ONFH after IF was 0.40-fold higher in patients with Garden III-IV FNF than that in patients with Garden I-II (OR: 0.40, 95%CI: 0.29–0.55). The risk of OFNH with retained IF was uplifted by 0.04 times (OR: 0.04, 95%CI: 0.02–0.07). There was nonsignificant relationship between gender and ONFH after IFFNF (OR: 1.27, 95%CI: 0.84–1.94). Moreover, ONFH after IFFNF presented no association with age (OR:1.66, 95%CI: 0.89–3.11), injury-operation interval (OR:1.29, 95%CI: 0.82–2.04), fracture reduction mode (OR:1.98, 95%CI: 0.92–4.26), preoperative traction (OR:1.69, 95%CI: 0.29–9.98) and mechanism of injury (OR:0.53, 95%CI: 0.06–4.83). Egger’s and Begg’s tests indicated a publication bias (P = 0.001).ConclusionIt was demonstrated that Garden classification and retained IF were important influencing factors of ONFH after IFFNF. Gender, age, injury-operation interval, fracture reduction mode, preoperative traction and the mechanism of ONFH were irrelevant to the complication.
Highlights
Femoral neck fracture (FNF) is a serious traumatic disease, accounting for about 50% of hip fractures
Studies had to fulfill the following criteria for inclusion: outcome was femoral head necrosis;internal fixation for femoral neck fracture;study design included case-control, retrospective,and prospective cohorts, and cross-sectional studies;participants were selected without limitations to regions, ages or social status.Trials were excluded according to following identifications: duplicate or overlapping data, animal experiments, conference abstracts, letters and review articles
7 full-text articles were abandoned because of the following reasons: 2 studies did not provide with full texts; 5 studies lacked the independent groups of Osteonecrosis of femoral head (ONFH)
Summary
FNF is a serious traumatic disease, accounting for about 50% of hip fractures. It mainly occurs after falls in the elderly, and is more common in middle-aged people due to violent injuries [1]. ONFH, or avascular necrosis of femoral head, is the ultimate consequence of impaired blood supply. ONFH and nonunion are two major complications after IFFNF, especially in the young group [6, 7]. The risk factors associated with osteonecrosis of femoral head (ONFH) after internal fixation of femoral neck fracture (IFFNF) have been frequently reported, the results remain controversial. Its related risk factors were systematically evaluated and meta-classified in this study
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