Yonsei Med J.  2022 Aug;63(8):744-750. 10.3349/ymj.2022.63.8.744.

Cephalomedullary Nailing versus Dynamic Hip Screw Fixation in Basicervical Femoral Neck Fracture: A Systematic Review and Meta-Analysis

Affiliations
  • 1Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, Incheon, Korea
  • 2Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
  • 3Department of Orthopaedic Surgery, Gachon University College of Medicine, Incheon, Korea
  • 4Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea

Abstract

Purpose
Although many studies have reported the use of dynamic hip screws (DHS) and cephalomedullary nailing (CMN) for basicervical femoral neck fracture (BFNF), no clear treatment protocols have been recommended. The present study aimed to compare the surgical outcomes associated with DHS and CMN to determine the appropriate fixation method for BFNF.
Materials and Methods
We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published up to January 9, 2021 that compared the treatment outcomes between CMN and DHS in BFNF. The primary outcomes of the present meta-analysis were fracture union time, postoperative cut-out rate, and reoperation rate.
Results
We included seven studies involving 353 cases of BFNF in our review. Of these, 206 patients were treated using CMN, and DHS were utilized in 147 patients. In a pooled analysis, the DHS group required a longer time to achieve fracture union compared to the CMN group [mean difference (MD): -0.41; 95% confidence interval (CI): -0.70, -0.12; p=0.006; I 2 =0%]. However, the cut-out and reoperation rates exhibited no statistically significant differences between the DHS and CMN groups [cut-out odds ratio (OR): 0.54; 95% CI: 0.10, 2.82; p=0.47; I 2 =24%, reoperation rate OR: 0.65; 95% CI: 0.15, 2.86; p=0.57; I 2 =19%, respectively].
Conclusion
Stable fixation using DHS and CMN does not show a significant clinical or radiographical difference in BFNF, and the implant can be selected based on the surgeon’s preference.

Keyword

Femoral neck fractures; osteosynthesis; meta-analysis
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