Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures.

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Abstract

[Indexed for MEDLINE] 4. J Orthop Surg (Hong Kong). 2021 Jan-Apr;29(1):23094990211003344. doi: 10.1177/23094990211003344. Treatment and outcomes of basicervical femoral neck fractures: A systematic review. Dekhne MS(1), Thomas HM(1), Haider T(2), Mortensen S(3), Rodriguez EK(1)(4), Weaver MJ(1)(5), von Keudell A(1)(5)(6). Author information: (1)Harvard Orthopaedic Trauma Initative, 1811Harvard Medical School, Boston, Massachusetts, USA. (2)Department of Orthopaedics and Trauma Surgery, 27271Medical University of Vienna, Waehringer Guertel 18-20,1090, Vienna, Austria. (3)Center for Advanced Orthopaedic Studies, 1859Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. (4)Department of Orthopaedic Surgery, 1859Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. (5)Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA. (6)Center for Surgery and Public Health, 1811Harvard Medical School, Boston, Massachusetts, USA. PURPOSE: This study aims to systematically review the literature comparing surgical treatments options and respective failure rates for basicervical hip fractures. METHODS: A comprehensive search of databases, including MEDLINE, Embase, Web of Science, and Cochrane Central for studies published in English on or before June 21, 2019 was performed. Selected search terms included "basicervical," "basi cervical," "AO/OTA type 31-B," "femoral neck fracture" AND "bone nails," "bone screws," "fracture fixation," "internal fixation," "arthroplasty," "cephalomedullary," "sliding hip screw," "ORIF," and "treatment outcome." We included studies that assessed outcomes of basicervical fracture fixation using open reduction internal fixation or arthroplasty. Two authors extracted the following data from each paper: study design, country, cohort year, definition of basicervical, intervention type, sample size, patient demographics, follow-up length, percent of fractures that required revision, and the percent of implants that failed. RESULTS: Sixteen articles encompassing 910 patients were included. The main outcome was the percent of implants that required revision. The total revision rates were 8% (8 studies, 157 patients, range 0%-55%) for cephalomedullary nails, 7% (10 studies, 584 patients, range 0%-18%) for sliding hip screws, 23% (3 studies, 40 patients, range 16%-50%) for cannulated screws, 0% (1 study, 6 patients) for total hip arthroplasty, and 8% (2 studies, 13 patients, range 0%-11%) for hemiarthroplasty. CONCLUSION: Management of basicervical fractures with SHS and CMN produces similar failure and re-operation rates. Limited evidence is available on the use of cannulated screws and arthroplasty, but available studies suggest that cannulated screws have an unacceptable revision rate (23%) while arthroplasty may be acceptable. Future studies examining the comparative efficacy of various fixation methods would benefit from strict definition of fracture type as well as consistent reporting of functional outcomes, re-operation rates, and mortality. DOI: 10.1177/23094990211003344