A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis

Abstract

BackgroundIt remains unclear whether conservative treatment should be used to treat the common undisplaced femoral neck fractures that develop in the elderly. Herein, we systematically review the rates of union and avascular necrosis after conservative and surgical treatment of undisplaced femoral neck fractures.MethodsWe searched the EMBASE, PubMed, OVID, Cochrane Library, Web of Science, and Scopus databases for randomized controlled trials or observational studies that assessed the outcomes of conservative or surgical treatments of undisplaced femoral neck fractures. No language or publication year limitation was imposed. Statistical analyses were performed with the aid of the chi-squared test. We evaluated the quality of each publication and the risk of bias.ResultsTwenty-nine studies involving 5071 patients were ultimately included; 1120 patients were treated conservatively and 3951 surgically. The union rates were 68.8% (642/933) and 92.6% (635/686) in the former and latter groups, respectively (p < 0.001). The avascular necrosis rate in the conservatively treated group was 10.3% (39/380), while it was 7.7% (159/2074) in the surgically treated group (p = 0.09).ConclusionsSurgery to treat undisplaced femoral neck fractures was associated with a higher union rate and a tendency toward less avascular necrosis than conservative treatment.

The Role of Strontium Enriched Hydroxyapatite and Tricalcium Phosphate Biomaterials in Osteoporotic Bone Regeneration

“…This protocol nowadays is used to induce constant osteoporosis, similar to our study. We found noticeable decrease in TBA between healthy rabbits and the experimental ones: the mean TBA in healthy rabbits was 0.393 mm 2 , and in operated animals it was from 0.206 mm 2 to 0.242 mm 2 , which is a 38-48% decrease. Our findings suggest that the established level of osteoporosis inducing bone remodeling changes was severe.…”

“…Osteoporosis is defined as a generalized skeletal disease with micro architectural bone changes and low mineral density, which leads to fragility and risk of fractures [1]. In the field of orthopedics, an osteoporotic femoral neck fracture is one of the most common and devastating injuries and, despite correct surgical fixation, avascular necrosis or metal implant dislocations can occur in up to 22.5% of bone surgery cases [2]. To overcome those complications, many attempts have been made to improve bone healing and mechanical stability of the prosthesis by creating physiologically active implant induced bone remodeling [3].…”

Dynamic compression locking system versus multiple cannulated compression screw for the treatment of femoral neck fractures: a comparative study

“…For elderly patients with displaced femoral neck fractures (Garden III/IV), the use of joint replacement surgery has basically reached consensus, but it has large trauma, high price, many early complications, and a high risk of surgery [2]. However, the treatment of elderly non-displaced femoral neck fractures (Garden I/II) is still controversial [3]. Given that non-surgical treatment of fractures is prone to re-displacement, the re-displacement is as high as 33-44%, and the fracture healing rate is only 44.38% [3].…”

“…However, the treatment of elderly non-displaced femoral neck fractures (Garden I/II) is still controversial [3]. Given that non-surgical treatment of fractures is prone to re-displacement, the re-displacement is as high as 33-44%, and the fracture healing rate is only 44.38% [3]. At present, elderly patients with non-displaced femoral neck fractures tend to be surgically treated [4].…”

Dynamic compression locking system versus multiple cannulated compression screw for the treatment of femoral neck fractures: a comparative study

“…The main complications of arthroplasty are periprosthetic dislocation, infection, and revision surgery, which potentially impact morbidity and quality of life and may contribute to mortality [3]. The treatment of elderly non-displaced femoral neck fractures (Garden I/II) is still controversial [4]. Given that non-surgical treatment of fractures is prone to re-displacement, the redisplacement is as high as 33% to 44%, and the fracture healing rate is only 44.38% [4].…”