Relationship between internal fixation removal and femoral head necrosis after femoral neck fracture in young and middle-aged patients: a meta-analysis

doi:10.3969/j.issn.2095-4344.1020

Abstract

Abstract:

BACKGROUND: Femoral neck fracture in young and middle-aged patients is mainly treated with closed reduction cannulated screws. However, how to deal with the cannulated screws after fracture healing remains unclear.

OBJECTIVE: To explore the association of implant removal or retention with femoral head necrosis, and to provide reference for the management of implant after femoral neck fracture in young and middle-aged patients.

METHODS: The English studies addressing implant removal or not effects on the femoral head necrosis after femoral neck fracture in the EMBASE, Cochrane Library, PubMed, WanFang, and CNKI databases were retrieved and from January 2000 to January 2018. Methodological quality of the trials was assessed, relevant data were extracted, and heterogeneity test was performed. A meta-analysis was conducted to calculate the OR value and 95%CI.

RESULTS AND CONCLUSION: (1) A total of 418 articles were searched and 20 eligible studies involving 6 271 patients were included. (2) The random effect model result showed that compared with implant maintenance, implant removal was more likely to cause femoral head necrosis (OR=2.49, 95%CI (1.47, 4.22), P=0.000 7). (3) Three articles mentioned the effect of implant removal on femoral head blood supply after femoral neck fracture. One article suggested that removing the implant after fracture healing would destroy the blood supply of the femoral head, doming harm to the reconstruction of the femoral head. Two articles considered that discontinuously removing the implant could improve femoral head blood supply. (4) The maximum compressive stress of the femoral head showed no significant change when the nail removal after fracture healing. However, the long-term presence of implant would increase the incidence of local bursitis and affect the function of injured limbs. (5) These results indicate that compared with the implant maintenance, implant removal is more likely to destroy the blood supply and induce femoral head necrosis. We should actively explore the removal method of the implant in young and middle-aged patients after femoral neck fracture to prevent femoral head necrosis.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Femoral Fractures, Femur Head Necrosis, Meta-Analysis, Tissue Engineering

CLC Number:

R459.9

Zhou Xin, Yang Yanfei, Niu Wenjie, Wei Xiaochun, Duan Wangping. Relationship between internal fixation removal and femoral head necrosis after femoral neck fracture in young and middle-aged patients: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(35): 5724-5729.

Figures/Tables 5

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