Effect of different types of internal fixation on the incidence of femoral head necrosis in adult femoral neck fractures: a single-arm rate and network meta-analysis.

BACKGROUND

Osteonecrosis of the femoral head (ONFH) remains a devastating complication following internal fixation of femoral neck fractures (FNFs). Despite advancements in fixation techniques, the comparative efficacy among methods for mitigating this risk remains unclear.

OBJECTIVE

To compare the impact of various internal fixation methods on the incidence of femoral head necrosis in adult femoral neck fractures based on single-arm rate and network meta-analysis (NMA).

PATIENTS AND

METHODS

PubMed, Embase, and Cochrane Library were searched (inception-September 2024). Eligible studies reported ONFH rates in adults treated with cannulated screws (CCS), dynamic hip screws (DHS), or femoral neck system (FNS). Single-arm rates were pooled via random-effects models; Bayesian NMA ranked interventions.

RESULTS

52 studies (5649 patients) were included. Pooled ONFH rates were CCS 15% (95% CI: 0.13-0.18; I2 = 83.5%); FNS 12% (95% CI: 0.02-0.28; I2 = 51.2%), DHS 29% (95% CI: 0.20-0.39 1 study). NMA ranked FNS + CCS (SUCRA = 0.63) and FNS alone (SUCRA = 0.52) as optimal followed by DHS (SUCRA = 0.34), DHS + CCS (SUCRA = 0.33), and CCS (SUCRA = 0.52). Anatomical reduction (OR = 0.35; 95% CI: 0.21-0.56) and Garden I-II fractures (OR = 0.30; 95% CI: 0.21-0.41) significantly reduced ONFH risk.

CONCLUSIONS

Based on available evidence, FNS is associated with the lowest incidence of ONFH. These findings, derived predominantly from observational data, are hypothesis-generating and warrant confirmation by high-quality randomized controlled trials.