Treatment of femoral neck fractures: sliding hip screw or cannulated screws? A meta-analysis

Yutong Xia,Jingcheng Wang,Lianqi Yan,Zhen Zhang,Wendong Zhang

doi:10.1186/s13018-020-02189-1

Abstract

PurposeFemoral neck fractures are still unsolved problems nowadays; sliding hip screw (SHS) and cannulated compression screw (CCS) are the most commonly used devices. We evaluated the clinical outcomes and complications in the treatment of femoral neck fractures between SHS and CCS in this meta-analysis to find which is better.MethodsWe searched PubMed, Embase, Cochrane library up to 24 August 2020 and retrieved any studies comparing sliding hip screw and cannulated compression screw in treatment of femoral neck fractures; the main outcomes and complications were extracted from the studies which were included.ResultsNine studies involving 1662 patients (828 patients in the SHS group and 834 patients in the CCS group) were included in this study. SHS had higher rate of avascular necrosis (RR = 1.30, 95% CI 1.08–1.56, p = 0.005), and CCS had higher rate of implant removal (RR = 0.63, 95% CI 0.43–0.93, p = 0.02). No significant statistical difference in non-union, implant failure, infection, replacement, mortality, orthopedic complications, non-orthopedic complications, and total revision between SHS and CCS group.ConclusionBoth devices have their pros and cons; SHS had a higher rate of avascular necrosis, and CCS had a higher rate of implant removal rate. No significant statistical difference in non-union, implant failure, infection, replacement, mortality, orthopedic complications, non-orthopedic complications, and total revision between SHS and CCS group.

Highlights

Femoral neck fractures account for more than half percent of all hip fractures; in elderly people, they are generally caused by low energy such as falling, as for young people, they are often caused by high energy like vehicle accidents [1,2,3]
We found a little heterogeneity between the studies (p = 0.05, I2 = 51%) and used the random-effect model to pool the data, result indicated no statistical difference in revision rate between the two groups (RR = 0.97, 95% confidence intervals (CI) 0.64–1.45, p = 0.87, Fig. 13)
sliding hip screw (SHS) and cannulated compression screw (CCS) are the most commonly used implants nowadays, but both of them have the disadvantage. In this meta-analysis, we can indicate that the avascular necrosis rate was higher in the SHS group, and the implant removal rate was higher in the CCS group

Summary

Introduction

Femoral neck fractures account for more than half percent of all hip fractures; in elderly people, they are generally caused by low energy such as falling, as for young people, they are often caused by high energy like vehicle accidents [1,2,3]. Femoral neck fractures will be continuously increasing in the 30 years [4], which will make a great medical and economic burden [5,6,7]. The. Xia et al Journal of Orthopaedic Surgery and Research (2021) 16:54 complications of internal fixation, such as avascular necrosis, non-union, implant failure, and reoperation [13, 14]. We must find the most reliable implant to deal with this kind of fracture, especially for young patients, internal fixation is the first choice. There is not any consensus on which is the real gold standard

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