Evidence-Based Medicine: Implants for Fixation of Femoral Neck Fractures

Is dynamic locking plate(Targon FN) a better choice for treating of intracapsular hip fracture? A meta-analysis

PURPOSE

The aim of this study was to assess the outcomes of dynamic locking plate (Targon FN) and other alternative implant (cannulated cancellous screws or sliding hip screw) for treating of intracapsular hip fracture.

METHODS

Relevant clinical trials on the dynamic locking plate and alternative implant treatment for intracapsular hip fracture were retrieved through searching the databases, PubMed, Embase and the Cochrane Central Register of Controlled Trials up to August 2017. Studies that investigated the comparing effectiveness or complications between both groups and provided sufficient data of interest were included in this meta-analysis.

RESULTS

Four studies involving 385 intracapsular hip fractures were included. The differences in nonunion [odds ratio (OR) 0.16,95% confidence interval (CI) 0.05-0.49], revision (OR 0.56, 95%CI 0.32-0.96) and replacement rate (OR 0.26, 95%CI 0.10-0.69) were statistically significant between dynamic locking plate and alternative implant group. There was no statistically significant difference in osteonecrosis (OR1.73, 95%CI0.59-5.02), cut-out (OR0.89,95%CI0.23-3.46)and non orthopaedics complication rate (OR0.73, 95% CI 0.38-1.41).

CONCLUSIONS

The available evidence indicate that dynamic locking plate offers a superior outcome in comparison with alternative implants and reduces the nonunion, revision and replacement rates for treating intracapsular hip fractures, but does not affect the osteonecrosis, cutout and non-orthopadeics complication rate. Decisions should be made in accordance with specific conditions for clinical application.

Contemporary management of femoral neck fractures: the young and the old

The optimal management strategy for femoral neck fractures remains highly debated. The femoral neck is intracapsular and the vascular supply is fragile. Furthermore, the curvature of the proximal femur results in high mechanical stresses through the femoral neck. Poor outcomes of nonunion and avascular necrosis (AVN) are common. This chapter reviews the current evidence with respect to the treatment principles of femoral neck fractures in two distinct patient populations: "young" and "old." Contemporary controversies including surgical timing, choice of implant, arthroplasty options, nonoperative management, capsulotomy, and associated complications will be discussed.

Optimal treatment of femoral neck fractures according to patient's physiologic age: an evidence-based review

For decades, the basic tenets of managing displaced femoral neck fractures have not changed, but the optimal treatment choice continues to be highly debated. The contemporary controversies associated with the treatment principles of displaced femoral neck fractures are distinct between young and old patients and are considered individually in this article about the current evidence. Although fixation constructs all seem to have similar complication rates, there is increasing evidence suggesting that total hip replacement improves patient functional outcomes for healthy, independent, elderly patients compared with hemiarthroplasty and should be considered as the treatment of choice for these patients.