Cephalomedullary Nailing versus Dynamic Hip Screw Fixation in Basicervical Femoral Neck Fracture: A Systematic Review and Meta-Analysis
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Purpose: Although many studies have reported the use of dynamic hip screws (DHS) and cephalomedullary nailing (CMN) forbasicervical femoral neck fracture (BFNF), no clear treatment protocols have been recommended. The present study aimed tocompare 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 toJanuary 9, 2021 that compared the treatment outcomes between CMN and DHS in BFNF. The primary outcomes of the presentmeta-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 com pared to the CMN group [mean difference (MD): -0.41; 95% confidence interval (CI): -0.70, -0.12; p=0.006; I2=0%]. However, thecut-out and reoperation rates exhibited no statistically significant differences between the DHS and CMN groups [cut-out odds ra tio (OR): 0.54; 95% CI: 0.10, 2.82; p=0.47; I2=24%, reoperation rate OR: 0.65; 95% CI: 0.15, 2.86; p=0.57; I2=19%, respectively]. Conclusion: Stable fixation using DHS and CMN does not show a significant clinical or radiographical difference in BFNF, andthe implant can be selected based on the surgeon’s preference.
Abstract
Purpose: Although many studies have reported the use of dynamic hip screws (DHS) and cephalomedullary nailing (CMN) forbasicervical femoral neck fracture (BFNF), no clear treatment protocols have been recommended. The present study aimed tocompare 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 toJanuary 9, 2021 that compared the treatment outcomes between CMN and DHS in BFNF. The primary outcomes of the presentmeta-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 com pared to the CMN group [mean difference (MD): -0.41; 95% confidence interval (CI): -0.70, -0.12; p=0.006; I2=0%]. However, thecut-out and reoperation rates exhibited no statistically significant differences between the DHS and CMN groups [cut-out odds ra tio (OR): 0.54; 95% CI: 0.10, 2.82; p=0.47; I2=24%, reoperation rate OR: 0.65; 95% CI: 0.15, 2.86; p=0.57; I2=19%, respectively]. Conclusion: Stable fixation using DHS and CMN does not show a significant clinical or radiographical difference in BFNF, andthe implant can be selected based on the surgeon’s preference.
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