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Preoperative posterior tilt can be a risk factor of fixation failure in nondisplaced femoral neck fracture: a systematic review and meta-analysis

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Abstract

Purpose

This systematic review and meta-analysis aimed to identify whether posterior tilt increases the risk of treatment failure in nondisplaced femoral neck fractures.

Methods

We searched the databases of the PubMed, Embase, and Cochrane Library from 1980 to 2022. The search strategy was based on the combination of keywords “nondisplaced,” “hip fracture,” “femoral neck fracture,” and “internal fixation.” Cohort studies enrolled patients with nondisplaced (Garden I and Garden II) femoral neck fractures were included. Two investigators independently extracted data and the other two assessed the methodological quality. Data were analyzed using Review Manager software.

Results

We analyzed 13 cohort trials with a pooled sample of 4818 patients, with posterior tilt ≥ 20° in 698 patients and < 20° in 3578 patients in 11 trials, and posterior tilt ≥ 10° in 483 patients and < 10° in 496 patients in 4 trials. All studies were of high quality based on Newcastle–Ottawa Scale evaluation. Treatment failure was reported in 24.4% (170/698) of patients with posterior tilt ≥ 20° and 10.9% (392/3578) of patients with posterior tilt < 20°, indicating that posterior tilt ≥ 20° was significantly associated with a higher risk of treatment failure (Risk ratio, 2.73; 95% confidence interval [CI], 1.77–4.21). Posterior tilt ≥ 10° was not found to be a risk factor for fixation failure (risk ratio, 1.92; 95% CI 0.76–4.83).

Conclusion

Nondisplaced femoral neck fractures with posterior tilt ≥ 20° were associated with an increasing rate of failure when treated with internal fixation.

Level of evidence 

III, Systematic review and meta-analysis.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

None.

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Funding

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Author notes

  1. Wei Wang and Zhifeng Huang contributed equally to this research and should be considered as co-first authors.

Authors and Affiliations

  1. Department of Orthopedics, Chongqing General Hospital, No. 118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147, China

    Wei Wang, Zhifeng Huang, Jing Peng, Jun Fan & Xiaotao Long

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Contributions

Jing P conceived the design of the study and prepared the manuscript. Wei W and Zhifeng H finished the literature search and data extraction, Jun F and Xiaotao Long assessed the methodological quality. Wei W, and Zhifeng H contributed to data analysis and prepared the manuscript.

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Correspondence to Jing Peng.

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This study is a meta-analysis. The Research Ethics Committee of Chongqing General hospital had confirmed that no ethical approval is required.

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Wang, W., Huang, Z., Peng, J. et al. Preoperative posterior tilt can be a risk factor of fixation failure in nondisplaced femoral neck fracture: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 33, 3197–3205 (2023). https://doi.org/10.1007/s00590-023-03518-w

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