Femoral neck system reduces surgical time and complications in adults with femoral neck fractures: A systematic review and meta-analysis

Saad, A. Ben; Patralekh, Mohit Kumar; Jain, Vijay Kumar; Shrestha, S; Botchu, Rajesh; Iyengar, Karthikeyan P

doi:10.1016/j.jcot.2022.101917

Cited by 7 publications

(5 citation statements)

References 38 publications

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“…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: 89%

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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Section: Reviewsupporting

confidence: 89%

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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“…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%

“…The Femoral Neck System (FNS) is a new generation of implant that reduces rotational displacement and provides angular stability; it is biomechanically superior to a fixation with 3 CS in unstable FNFs [ 9 ]. In 2022, multiple clinical studies and meta-analyses have been published on the FNS, with complication rates estimated between 9.2% and 13.3% [ 10 – 12 ].…”

Section: Introductionmentioning

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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“…The femoral neck system (FNS), which is a minimally invasive implant, has been recently developed and utilized with superior biomechanical stability [ 6 – 8 ]. Thus, we conducted this study to analyze the outcomes of FNFs treated with FNS.…”

Section: Introductionmentioning

confidence: 99%

Nonanatomical reduction of femoral neck fractures in young patients treated with femoral neck system: a retrospective cohort study

Jiang

Liu

Bai

et al. 2023

BMC Musculoskelet Disord

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Purpose Negative buttress reduction should be avoided in the treatment of femoral neck fractures (FNFs) using conventional fixation. As the femoral neck system (FNS) has been recently developed and utilized widely to treat FNFs, the association of reduction quality with postoperative complications and clinical function has not been clarified. The purpose of this study was to evaluate the clinical effect of nonanatomical reduction in young patients with FNFs treated with FNS. Methods This multicenter, retrospective cohort study included 58 patients with FNFs treated with FNS between September 2019 and December 2021. According to the reduction quality immediately following surgery, patients were classified into positive, anatomical, and negative buttress reduction groups. Postoperative complications were assessed with 12 months of follow-up. The logistic regression model was used to identify risk factors for postoperative complications. The postoperative hip function was assessed using the Harris hip scores (HHS) system. Results At a follow-up of 12 months, a total of eight patients (8/58, 13.8%) had postoperative complications in three groups. Compared with the anatomical reduction group, negative buttress reduction was significantly associated with a higher complication rate (OR = 2.99, 95%CI 1.10–8.10, P = 0.03). No significant associations were found between positive buttress reduction and the incidence of postoperative complications (OR = 1.21, 95%CI 0.35–4.14, P = 0.76). The difference was not statistically significant in Harris hip scores. Conclusion Negative buttress reduction should be avoided in young patients with FNFs treated with FNS.

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Femoral neck system reduces surgical time and complications in adults with femoral neck fractures: A systematic review and meta-analysis

Cited by 7 publications

References 38 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

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

Nonanatomical reduction of femoral neck fractures in young patients treated with femoral neck system: a retrospective cohort study

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