Comparison of clinical efficacy between femoral neck system and cannulated screw in Pauwels type III femoral neck fracture: A meta-analysis.

Background: In recent years, the femoral neck system (FNS) has become increasingly widely used for Pauwels type III femoral neck fractures.

Objective: We performed a meta-analysis to investigate the safety and efficacy of FNS and the mainstream internal fixation method, cannulated screw (CS), in the treatment of Pauwels type III femoral neck fractures.

Methods: We systematically searched all research studies from PubMed, Embase, Web of Science, Cochrane, WANFANG, and the Chinese Academic Journal Full-Text Database (CNKI) from 2018 to July 2024 and conducted data extraction. The study was conducted on July 26, 2024. We used the PRISMA guidelines to assess the quality of the results of all included studies. In addition, we searched for references to relevant articles. After completing the literature search, we performed a manual literature screening to obtain studies that met the inclusion criteria. The outcomes were Harris Hip Score, operation duration, intraoperative blood loss, hospital stay, healing time, and postoperative complications.

Results: This meta-analysis ultimately included nine studies (n = 524) and conducted quality evaluations. All nine articles were retrospective cohort studies. The study exhibited statistically significant variations between the FNS and CS groups in relation to total complications (95% confidence interval (CI)= [0.11, 0.40], odds ratio (OR) = 0.21, P < 0.001), Harris Hip Score (95%CI = [2.14, 3.65], mean difference (MD) = 2.89, P < 0.001), Femoral head necrosis (95%CI = [0.17, 0.86], OR = 0.38, P = 0.02), Internal fixation failure (95%CI = [0.06, 0.50], OR = 0.17, P = 0.001), Medium femoral neck shortening (95%CI = [0.17, 0.53], OR = 0.30, P < 0.001), intraoperative blood loss (95%CI = [11.57, 26.80], MD = 19.19, P < 0.001), Operation duration (95%CI = [-15.20, -2.17], MD = -8.69, P = 0.009), and healing time (95%CI = [-1.30, -0.32], MD = -0.81, P = 0.001).

Conclusion: This meta-analysis showed that in Pauwels type III femoral neck fractures, the femoral neck system has a shorter operative time, a lower rate of postoperative complications, a shorter healing time, less shortening of the femoral neck, and a higher Harris Hip Score compared with cannulated screws, but increases intraoperative blood loss. However, more clinical studies are needed to confirm our conclusions due to our small sample size and lack of randomized controlled trials.