Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (6): 924-930.doi: 10.3969/j.issn.2095-4344.2429

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Systematic review of triangle versus inverted triangle-configurated cannulated screws in the treatment of femoral neck fractures

Ruan Zhe, Zhu Yong, Lin Zhangyuan, Long Haitao, Zhao Ruibo, Lu Bangbao, Sun Buhua, Cheng Liang,  Zeng Min, Zhao Shushan   

  1. Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
  • Received:2019-06-18 Revised:2019-06-21 Accepted:2019-07-31 Online:2020-02-28 Published:2020-01-18
  • Contact: Zhao Shushan, MD, Attending physician, Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
  • About author:Ruan Zhe, Master candidate, Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China Zhu Yong, MD, Chief physician, Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China Ruan Zhe and Zhu Yong contributed equally to this paper
  • Supported by:
     the National Natural Science Foundation of China, No. 81874006

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Abstract:

BACKGROUND: The use of three cannulated screws is the preferred method for the treatment of femoral neck fractures for many years. However, some clinical studies have explored the clinical efficacy of triangular and inverted triangular hollow screw internal fixation in the treatment of femoral neck fracture, but the conclusions are not consistent.

OBJECTIVE: To systematically review the efficacy of triangle and inverted triangle-configurated cannulated screws in the treatment of femoral neck fractures.

METHODS: The PubMed, Cochrane Library, EMbase, CNKI and WanFang Database were searched up to May 2018, for studies concerning the efficacy of three cannulated screws fixation for femoral neck fractures. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. The meta-analysis and trial sequential analysis were performed by using RevMan 5.3 software and TSA 0.9 respectively.

RESULTS AND CONCLUSION: (1) A total of 8 cohort studies involving 1 150 patients were included. (2) The results of meta-analysis showed that compared with the inverted triangle group, the triangle group was inferior in operation time [MD=12.30, 95%CI(4.83, 19.77), P < 0.01] and blood loss during the operation [MD=12.44, 95%CI(6.56, 18.32), P < 0.01]. However, there were no statistical differences between the two groups in femoral head osteonecrosis rate [OR=0.66, 95%CI(0.34, 1.29), P=0.22], nonunion rate [OR=1.37, 95%CI(0.86, 2.18), P=0.18] and the Harris scores in the final follow-up [OR=1.29, 95%CI(0.58, 2.26), P=0.53]. (3) Current evidence shows that inverted triangle group is superior to triangle group in shorting operation time and reducing blood loss. Nevertheless, there was no significant difference in femoral head osteonecrosis rate, nonunion rate, and the Harris scores < 70 in the final follow up. Because the inclusion of the study is mainly cohort study, and there is a large bias, so the above conclusions need to be verified by more multi-center randomized controlled trials.

Key words: triangle, cannulated screw, femoral neck fracture, systematic review, meta-analysis, trial sequential analysis

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