Does the femoral neck system provide better outcomes compared to cannulated screws fixation for the management of femoral neck fracture in young adults? A systematic review of literature and meta-analysis

Rajnish, Rajesh Kumar; Srivastava, Amit; Rathod, Pratik M; Haq, Rehan Ul; Aggarwal, Sameer; Kumar, Prasoon; Dhammi, Ish Kumar; Dadra, Ankit

doi:10.1016/j.jor.2022.05.007

Cited by 22 publications

(7 citation statements)

References 16 publications

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“…The follow-up duration ranges from 6 to 24 months. Our results coincide with the findings mentioned by Rajnish et al in their study [13].…”

Section: Discussionsupporting

confidence: 94%

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Comparison of Femoral Neck System Versus Cannulated Cancellous Screws for the Fixation of Femoral Neck Fracture in Young Adults: A Systematic Review and Meta-Analysis

Gupta¹,

Rai²,

Mandal³

et al. 2022

Cureus

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A femoral neck fracture is a very common injury in the elderly. However, its incidence is low among young adults, usually presenting as an emergency. In young adults, implant choice is one of the important factors. This systematic review aims to analyze the femoral neck system (FNS) versus cannulated cancellous (CC) screw for the fixation of femoral neck fractures in young adults through well-defined objectives. A comprehensive search from the electronic database (PubMed, Google Scholar, Web of Science, Cochrane Library) was conducted from the beginning till February 18, 2022. The data regarding study type, authors, year of publication, country, union time, Harris hip score, intraoperative blood loss, operating time, neck shortening, and hospital stay were extracted from the selected articles and analyzed using RevMan 5.4.1 software. For continuous data, e.g., healing time, intraoperative blood loss, operation time, Harris hip score, neck shortening, and hospital stay, the mean difference (MD), either weighted mean difference (WMD) or standardized mean difference (SMD), with a 95% confidence interval (CI) was recorded. A p-value less than 0.05 was taken as statistically significant. The Newcastle Ottawa scale was used for the risk of bias assessment. Six retrospective cohort studies including 427 patients were selected for the meta-analysis. There was significantly less healing time (WMD= -1.10, 95% CI: -1.73 to -0.47), shorter operation duration (WMD=7.70, 95% CI: -0.06 to 15.46), and better Harris hip score (WMD=4.79, 95% CI: 2.12-7.46) in the FNS than CC screw fixation method. However, intraoperative blood loss was significantly less in the CC screw system (WMD=21.27, 95% CI: 8.20-34.35). There was no significant difference between the two approaches in-hospital stay duration and femoral neck shortening. This can be concluded that FNS is better than CC screw fixation for treating neck of femur fractures in adults on the outcome basis of union time, less operation time, and better Harris hip score (HHS) with significant heterogeneity.

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“…The follow-up duration ranges from 6 to 24 months. Our results coincide with the findings mentioned by Rajnish et al in their study [13].…”

Section: Discussionsupporting

confidence: 94%

“…According to our meta-analysis, there was significantly more blood loss in FNS than in CC screw fixation procedure (WMD=21.27; 95% CI: 8.20 to 34.35)]. The finding was similar to the previous review [ 13 , 17 ].…”

Section: Reviewsupporting

confidence: 88%

Comparison of Femoral Neck System Versus Cannulated Cancellous Screws for the Fixation of Femoral Neck Fracture in Young Adults: A Systematic Review and Meta-Analysis

Gupta¹,

Rai²,

Mandal³

et al. 2022

Cureus

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“…The Femoral Neck System (FNS, DePuy Synthes, Oberdorf, Switzerland), for which various clinical results have been recently reported, enables minimally invasive fixation similar to the multiple lag screw technique and has mechanical strength comparable to that of the dynamic hip screw (DHS) [ 12 , 13 ]. However, disappointing results were reported in a meta-analysis of studies that reported clinical results using a three-triangular multiple lag screw and the FNS for the fixation of femoral neck fractures [ 14 ]. Although neck shortening was reduced with the FNS, compared with the three-triangular multiple lag screw, there was no difference in the final functional status and in the rates of complications, such as implant failure and non-union [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, disappointing results were reported in a meta-analysis of studies that reported clinical results using a three-triangular multiple lag screw and the FNS for the fixation of femoral neck fractures [ 14 ]. Although neck shortening was reduced with the FNS, compared with the three-triangular multiple lag screw, there was no difference in the final functional status and in the rates of complications, such as implant failure and non-union [ 14 ]. Thus, we believe that improvements should be made to the FNS to enhance fixation stability.…”

Section: Introductionmentioning

confidence: 99%

Pre-sliding of femoral neck system improves fixation stability in pauwels type III femoral neck fracture: a finite element analysis

Cha

Chung

Jung

et al. 2023

BMC Musculoskelet Disord

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Background Femoral neck fractures are a common injury in older adults and their management presents a significant challenge for orthopedic surgeons. The Femoral Neck System (FNS) was recently introduced for the fixation of femur neck fractures. Although neck shortening was reduced with the FNS, the complication rates were not reduced. Thus, improvements to enhance fixation stability should be made for the FNS. We hypothesized that (1) the pre-sliding technique and (2) the use of longer anti-rotation screw would increase fracture stability. This study aimed to determine the change in fracture stability using the pre-sliding technique and long anti-rotation screw in the FNS for fixation of Pauwels type III femoral neck fractures. Methods Finite element models of Pauwels type III femoral neck fracture fixed with pre-sliding FNS and 5-mm longer anti-rotation screw were established. The models were subjected to normal walking load. The material properties of the elements belonging to the bone were mapped by assigning the formulation with the computed tomography Hounsfield unit. Results Pauwels type III femoral neck fractures fixed with pre-slided FNS showed better fracture stability, decreasing fracture gap and sliding by 14% and 12%, respectively, under normal walking load. No element of cortical bone in any of the models had an absolute value of principal strain that exceeded 1%. The peak von Mises stress (VMS) of the implants ranged from 260 to 289 MPa, and the highest peak VMS value was 50% lower than the yield strength of the titanium alloy (800 MPa). The longer anti-rotation screw did not affect fracture stability. Conclusions The pre-sliding technique using the FNS showed higher fracture stability than the standard fixation technique for a Pauwels type III femoral neck fracture. The longer anti-rotation screw did not contribute significantly to fixation stability. As this finite element analysis considered the inhomogeneous mechanical property of the bone, it offered equivalent mechanical conditions to investigate the components of interest.

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“…Multiple systematic review or meta-analyses have been published in 2022 on the FNS; all of them included only retrospective studies, suggesting that our study is likely the only prospective study in the FNS field [ 3 , 11 , 12 , 22 ]. Due to the retrospective study design, very few previous studies have included patient-reported outcomes and none had collected preinjury patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Clinical performance of the Femoral Neck System within 1 year in 125 patients with acute femoral neck fractures, a prospective observational case series

Stoffel

Michelitsch

Arora

et al. 2022

Arch Orthop Trauma Surg

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Introduction Osteosynthesis of femoral neck fractures (FNFs) is an important treatment option, especially for younger patients. We aimed to assess the rate of early implant-related complications in FNF osteosynthesis using the Femoral Neck System (FNS). Patients and methods Consecutive patients diagnosed with displaced or nondisplaced FNFs were treated with FNS in this prospective, observational, multicenter investigation. Patients were followed up for minimally 3 months and up to 12 months if radiologic bone union and no pain was not achieved beforehand. Predefined treatment-related adverse events (AEs, defined as implant failure, loss of reduction, iatrogenic fractures, deep infection, and surgical revision), radiologic bone union, and patient-reported Harris hip score (HHS) and EQ-5D-5L index score were assessed. Results One hundred and twenty-five patients were included in the study. Thirty-eight (30.4%) fractures were displaced (Garden III and IV), and 37 (29.6%) were vertical fractures (Pauwels type III). Predefined treatment-related AE rate at 3 months was 8 patients, 6.4% (95% CI, 2.8–12.2), and at 12 months, 11 patients, 8.8% (95% CI, 4.5–15.2). Cumulative incidences of bone union were 68% at 3 months, 90% at 6 months, and 98% at 12 months. The mean changes of HHS and EQ-5D-5L index score between preinjury and at 12 months were -7.5 (95% CI, [ – 21.1] to [6.2]) and – 0.03 (95% CI, [ – 0.21] to [0.15]), respectively; neither were statistically significant. Conclusion The current study on osteosynthesis of FNFs with the FNS resulted in treatment-related complication rates of 6.4% (95% CI, 2.8–12.2) at 3 months and 8.8% (95% CI, 4.5–15.2) at 12 months. On average, patients returned to preinjury function and quality of life. The current study may also indicate that the conventional wisdom of treating stable FNF in patients aged between 60 and 80 years with osteosynthesis may need to be reconsidered. Registration The study is registered with ClinicalTrials.gov (registration number: NCT02422355).

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Does the femoral neck system provide better outcomes compared to cannulated screws fixation for the management of femoral neck fracture in young adults? A systematic review of literature and meta-analysis

Cited by 22 publications

References 16 publications

Comparison of Femoral Neck System Versus Cannulated Cancellous Screws for the Fixation of Femoral Neck Fracture in Young Adults: A Systematic Review and Meta-Analysis

Comparison of Femoral Neck System Versus Cannulated Cancellous Screws for the Fixation of Femoral Neck Fracture in Young Adults: A Systematic Review and Meta-Analysis

Pre-sliding of femoral neck system improves fixation stability in pauwels type III femoral neck fracture: a finite element analysis

Clinical performance of the Femoral Neck System within 1 year in 125 patients with acute femoral neck fractures, a prospective observational case series

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