Management of Garden-I and II Femoral Neck Fractures: Perspectives on Primary Arthroplasty

The therapeutic effect of fixation using alternative implants for the treatment of hip fractures (FAITH) in elderly patients with femoral neck fractures after falls: a meta-analysis

BACKGROUND

Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) is widely used for the treatment of femoral neck fractures.

AIM

This study conducted a comparative and meta-analysis of the therapeutic effects of different screw fixation methods in femoral neck fractures, with the aim of finding a better treatment.

METHODS

Pubmed, Embase, Cochrane Library and Web of science databases were searched using MeSH Terms combined with free words without time or language constraints. MeSH Terms were "femoral neck fractures", "Sliding Hip Screw", "Cancellous Screws", "Fixation using Alternative Implants for the Treatment of Hip fractures", "over 50 years old". The search deadline is August 15, 2024. Two researchers sifted through the retrieved literature to come up with the included literature. After a close reading of the literature, Review Manager 5.4 was used to analyze the risk of bias in the included literature, compare various indicators of different screw fixation, and make forest and funnel maps.

RESULTS

214 literatures were retrieved from 4 databases were included in the study after screening. The bias of the included literature is good, and the randomness and blindness are clearly indicated in this paper. Pauwels Type III (Chi2 = 0.00, df = 3, I2 = 0%, z = 0.80, p = 0.43), fall (Chi2 = 2.23, df = 2, I2 = 10%, z = 1.88, p = 0.06) and Mortality (Chi2 = 4.80, df = 2, I2 = 58%, z = 3.53, p = 0.0004) were lower in sliding hip screws than in cancellous screws. Garden type III and IV (Chi2 = 1.37, df = 3, I2 = 0%, z = 0.71, p = 0.48) and Infection (Chi2 = 0.01, df = 2, I2 = 0%, z = 0.28, p = 0.78) were lower in sliding hip screws than in cancellous screws (Both p > 0.05).

CONCLUSIONS

In Femoral neck fractures, sliding hip screws have a distinct advantage over cancellous screws. This has guiding significance for clinical treatment. Elderly patients with femoral neck fractures should be given priority for fixation with sliding hip screws.

Impact of Surgical Timing on Fracture Healing in Tibial Shaft Injuries: A Comparative Review of Intramedullary Nailing Techniques

Tibial shaft fractures are a prevalent and challenging orthopedic injury, often resulting from high-energy trauma. Optimal management of these fractures is crucial to prevent complications such as nonunion, malunion, and prolonged functional impairment. Intramedullary nailing (IMN) is widely regarded as the gold standard for treating these injuries due to its ability to provide stable fixation, preserve soft tissues, and enable early mobilization. However, the timing of surgical intervention remains a topic of ongoing debate. Early surgical intervention, defined as surgery within 24-48 hours of injury, is advocated for its potential to reduce hospital stay, facilitate early mobilization, and decrease the risk of secondary complications such as compartment syndrome. Conversely, delayed intervention allows for patient stabilization and reduction of soft tissue swelling, potentially lowering the risk of infection and other complications. This comprehensive review aims to evaluate the impact of surgical timing on fracture healing outcomes in tibial shaft fractures treated with IMN. It explores the benefits and limitations of early versus delayed surgery, emphasizing their influence on union rates, healing time, and complication rates. Furthermore, the review examines different IMN techniques, including reamed versus unreamed and static versus dynamic nailing, to determine their role in optimizing fracture healing. By synthesizing current evidence, this review provides critical insights into the optimal timing and technique for IMN in tibial shaft fractures, ultimately aiming to guide clinical decision-making and improve patient outcomes. Future research should focus on randomized controlled trials to establish standardized surgical timing and technique selection guidelines in this patient population.

Hemiarthroplasty vs. internal fixation for nondisplaced femoral neck fracture in mainland China: a cost-effectiveness analysis

Objective

Nondisplaced femoral neck fractures constitute a substantial portion of these injuries. The optimal treatment strategy between internal fixation (IF) and hemiarthroplasty (HA) remains debated, particularly concerning cost-effectiveness.

Methods

We conducted a cost-effectiveness analysis using a Markov decision model to compare HA and IF in treating nondisplaced femoral neck fractures in elderly patients in China. The analysis was performed from a payer perspective with a 5-year time horizon. Costs were measured in 2020 USD, and effectiveness was measured in quality-adjusted life-years (QALYs). Sensitivity analyses, including one-way and probabilistic analyses, were conducted to assess the robustness of the results. The willingness-to-pay threshold for incremental cost-effectiveness ratio (ICER) was set at $11,083/QALY following the Chinese gross domestic product in 2020.

Results

HA demonstrated higher cumulative QALYs (2.94) compared to IF (2.75) but at a higher total cost ($13,324 vs. $12,167), resulting in an ICER of $6,128.52/QALY. The one-way sensitivity analysis identified the costs of HA and IF as the most influential factors. Probabilistic sensitivity analysis indicated that HA was more effective in 69.3% of simulations, with an ICER below the willingness-to-pay threshold of $11,083 in 58.8% of simulations.

Conclusions

HA is a cost-effective alternative to IF for treating nondisplaced femoral neck fractures in elderly patients in mainland China.