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Sliding hip screws versus cancellous screws for femoral neck fractures: a systematic review and meta-analysis

  • General Review • HIP - FRACTURES
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Both sliding hip screws (SHS) and cancellous screws are used in the surgical management of intracapsular femoral neck fracture. However, there is paucity of information as to which is the superior treatment modality. We performed this systematic review and meta-analysis study to compare the clinical outcomes of SHS and cancellous screws for the treatment of femoral neck fractures in adult patients.

Methods

We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL, up to December 2017. Randomized controlled trials (RCTs) directly comparing the clinical outcomes of SHS and cancellous screws for femoral neck fractures were retrieved with no language or publication year restrictions. Data retrieved included operative details, nonunion rate, avascular necrosis, reoperation, infection and mortality, hip pain, functional hip scores, and medical complications. These were pooled as risk ratio or mean difference (MD) with their corresponding 95% confidence interval (CI). Heterogeneity was assessed by Chi-square test.

Results

Ten RCTs involving 1934 patients were included in the final analysis. The pooled estimate showed that the SHS group was associated with more intraoperative blood loss (MD = 110.01 ml, 95% CI [52.42, 167.60], p = 0.00002) than the cancellous screws. There was no significant difference in terms of operative time, postoperative hip function, nonunion, avascular necrosis, reoperation rate, infection, fracture healing, hip pain, medical complications, and mortality rate.

Conclusion

Based on our study, the cancellous screws group was associated with less intraoperative blood loss in comparison with the SHS group. No other significant differences were found between the two interventions.

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Authors and Affiliations

  1. Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Mohamed S. A. Shehata & Hussien Ahmed

  2. Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed M. Aboelnas & Ali N. Abdulkarim

  3. Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Ahmed R. Abdallah

  4. Oxford University Hospitals, Oxford, UK

    James Holton

  5. St George Trauma Centre, London, UK

    Paolo Consigliere

  6. Rowley Bristow Orthopaedic Center, St Peter’s Hospital, Chertsey, UK

    Ali A. Narvani

  7. Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Kilo 4.5 Ring Road, Ismailia, 41111, Egypt

    Asser A. Sallam & Mohamed A. Imam

  8. Norfolk and Norwich University Hospital, University of East Anglia, Norwich, UK

    James A. Wimhurst & Mohamed A. Imam

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  1. Mohamed S. A. Shehata
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Correspondence to Asser A. Sallam.

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Shehata, M.S.A., Aboelnas, M.M., Abdulkarim, A.N. et al. Sliding hip screws versus cancellous screws for femoral neck fractures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 29, 1383–1393 (2019). https://doi.org/10.1007/s00590-019-02460-0

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