Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: a meta-analysis

BMC Musculoskeletal Disorders

Pingshan Wang¹  Xuecheng Cao¹  Hui Rong¹  Yuan Zhang¹  Wenkun Zhuo¹  Zhanwang Xu³  Junjie Wei²  Weiguo Wang⁴ 

[1] Department of Orthopaedic Surgery, General Hospital of Jinan Military Command, 250031 Jinan, China;Outpatient Department, General Hospital of Jinan Military Command, 250031 Jinan, China;Department of Orthopaedics, The First Affiliated Hospital of Shandong University of Traditional Chinese Medicine, NO.16369, Jingshi Road, 250014 Jinan, China;Research on 2013 stage doctoral student of TCM Orthopaedics, Shandong University of Traditional Chinese Medicine, Jinan, China

关键词: Closed reduction internal fixation;    Open reduction internal fixation;    Femoral neck fracture;   

Others  :  1125711
DOI  :  10.1186/1471-2474-15-167

 received in 2013-10-09, accepted in 2014-04-23,  发布年份 2014

【 摘 要 】

Background

A meta-analysis was performed to assess the association between healing rate, avascular necrosis (AVN) of femoral head and two reductions-open reduction internal fixation (ORIF) and closed reduction internal fixation (CRIF) for femoral neck fracture.

Methods

A literature-based search was conducted to identify all relevant studies published before September 10, 2013. The odd ratio (OR) and 95% confidence interval (CI) were used for estimating the effects of the two reduction methods. Data were independently extracted by two investigators who reached a consensus on all of the items. The heterogeneity between studies was examined by χ²-based Q statistic. Egger’s regression analysis was used to evaluate publication bias. Statistical analysis was performed by Stata 10.0 software.

Results

We examined 14 publications. The results of the present meta-analysis showed that AVN of femoral head were significant associated with the two reductions (CRIF vs. ORIF, OR = 1.746, 95% CI 1.159-2.628, p = 0.008), while the healing rate were not (CRIF vs. ORIF, OR = 0.853, 95% CI 0.573-1.270, p = 0.433).

Conclusion

The present meta-analysis indicated the risk of AVN of femoral head was significant higher after CRIF fixation compared with ORIF, but no association between the healing rate and the two reductions for femoral neck fracture.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Iorio R, Schwartz B, Macaulay W, Teeney SM, Healy WL, York S: Surgical treatment of displaced femoral neck fractures in the elderly: a survey of the American Association of Hip and Knee Surgeons. J Arthroplasty 2006, 21:1124-1133.
• [2]Kyle RF: Fractures of the femoral neck. Instr Course Lect 2009, 58:61-68.
• [3]Kurtinaitis J, Dadonienė J, Kvederas G, Porvaneckas N, Butėnas T: Mortality after femoral neck fractures: a two-year follow-up. Medicina (Kaunas) 2012, 48:145-149.
• [4]Schmidt AH, Swiontkowski MF: Femoral neck fractures. Orthop Clin North Am 2002, 33:97-111.
• [5]Gjertsen J-E, Vinje T, Engesaeter L, Lie S, Havelin L, Furnes O, Fevang J: Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. J Bone Joint Surg Am 2010, 92:619-628.
• [6]Gautam VK, Anand S, Dhaon BK: Management of displaced femoral neck fractures in young adults (a group at risk). Injury 1998, 29:215-218.
• [7]Open reduction and internal fixation (ORIF) http://intermountainhealthcare.org/ext/Dcmnt?ncid=521402750 webcite
• [8]Chaudhuri S: Closed reduction, internal fixation with quadratus femoris muscle pedicle bone grafting in displaced femoral neck fracture. Indian J Orthop 2008, 42:33-38.
• [9]Ross JR, Gardner MJ: Femoral head fractures. Curr Rev Musculoskelet Med 2012, 5:199-205.
• [10]Cochran WG: The combination of estimates from different experiments. Biometrics 1954, 10:101-129.
• [11]Liu Z, Liu X, Gong H, Wang Y, Fan W: Comparison of two methods for the treament of femoral neck fractures. China J Orthop Trauma 2003, 16:257-259.
• [12]Wang Y: An analysis of the surgical treated 62 cases with femoral neck fracture in youth. Chin Gen Pract 2005, 8:1970-1971.
• [13]Song KS: Displaced fracture of the femoral neck in children: open versus closed reduction. J Bone Joint Surg (Br) 2010, 92:1148-1151.
• [14]Zhang M: Early closed reduction and internal fixation of 50 cases of simple fracture of the femoral neck. China Health Industry 2011, 8:4-5.
• [15]Ye Z, Qi C, Duan L: Comparative analysis of open reduction and closed reduction in the treatment of femoral neck fractures. China Prac Med 2005, 6:54-55.
• [16]LiN Z, Sun Y, Wu X, Liu Z, Yin S: Comparison of the efect between early anatomical open reduction, internal fixation and closed reduction, internal fixation for treatment of children displaced femoral neck fracture. China J Orthop Trauma 2012, 25:546-548.
• [17]Zhou F, Hu Z, Liang W, Li L, Cao S, Ye L: Therapeutic effect of two methods in the treatment of femoral neck fractures in young. J Pract Orthop 2012, 18:835-837.
• [18]Xia Y: Comparison of two ways in the treatment of displaced femoral neck fracture. Mod Med Health 2013, 29:247-248.
• [19]Zhang F: Compared the efficacy of open reduction and closed reduction in the treatment of femoral neck fracture. Guide China Med 2013, 11:169-171.
• [20]Upadhyay A, Jain P, Mishra P, Maini L, Gautum VK, Dhaon BK: Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction. J Bone Joint Surg (Br) 2004, 86:1035-1040.
• [21]Gao X, Sun F, GE G, Qiu H: A comparison study on open and closed reduction plus cannulated screws system for femoral neck fractures. J Pract Orthop 2008, 14:265-267.
• [22]Kan W, Zheng Q, Hu J, Chen M, Wang J, Cheng W, Xu M: Open reduction versus closed reduction in treatment of femoral neck fractures. Chin J Orthop Trauma 2008, 13:401-405.
• [23]Bali K, Sudesh P, Patel S, Kumar V, Saini U, Dhillon M: Pediatric femoral neck fractures: our 10 years of experience. Clin Orthop Surg 2011, 3:302-308.
• [24]Javdan M, Bahadori M, Hosseini A: Evaluation the treatment outcomes of intracapsular femoral neck fractures with closed or open reduction and internal fixation by screw in 18-50-year-old patients in Isfahan from Nov 2010 to Nov 2011. Adv Biomed Res 2013, 2:1-14.
• [25]Razik F, Alexopoulos A-S, El-Osta B, Connolly MJ, Brown A, Hassan S, Ravikumar K: Time to internal fixation of femoral neck fractures in patients under sixty years—does this matter in the development of osteonecrosis of femoral head? Int Orthop 2012, 36:2127-2132.
• [26]Vandermeer JS, Kamiya N, Aya-ay J, Garces A, Browne R, Kim HK: Local administration of ibandronate and bone morphogenetic protein-2 after ischemic osteonecrosis of the immature femoral head a combined therapy that stimulates bone formation and decreases femoral head deformity. J Bone Joint Surg Am 2011, 93:905-913.
• [27]Miyata N, Kumagai K, Osaki M, Murata M, Tomita M, Hozumi A, Nozaki Y, Niwa M: Pentosan reduces osteonecrosis of femoral head in SHRSP. Clin Exp Hypertens 2011, 32:511-516.
• [28]Ko J-Y, Wang F-S, Wang C-J, Wong T, Chou W-Y, Tseng S-L: Increased Dickkopf-1 expression accelerates bone cell apoptosis in femoral head osteonecrosis. Bone 2010, 46:584-591.
• [29]Raaymakers EL, Marti RK: Nonunion of the femoral neck: possibilities and limitations of the various treatment modalities. Indian J Orthop 2008, 42:13-21.
• [30]Parker MJ, Raghavan R, Gurusamy K: Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res 2007, 458:175-179.
• [31]Huang HK, Su YP, Chen CM, Chiu FY, Liu CL: Displaced femoral neck fractures in young adults treated with closed reduction and internal fixation. Orthopedics 2010, 33:873-884.
• [32]Bimmel R, Bakker A, Bosma B, Michielsen J, Monica FAZ: Paediatric hip fractures: a systematic review of incidence, treatment options and complications. Acta Orthop Belg 2010, 76:7-13.
• [33]Ly TV, Swiontkowski MF: Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am 2008, 90:2254-2266.
• [34]Garden R: Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br 1971, 53:183-197.
• [35]Pauwels F: Der Schenkelhalsbruch: ein mechanisches Problem: grundlagen des Heilungsvorganges, Prognose und Kausale Theapie. 1935.
• [36]Mirdad T: Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia. Injury 2002, 33:823-827.