European Journal of Orthopaedic Surgery & Traumatology Pub Date : 2023-03-22 , DOI: 10.1007/s00590-023-03518-w Wei Wang 1 , Zhifeng Huang 1 , Jing Peng 1 , Jun Fan 1 , Xiaotao Long 1
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Purpose
This systematic review and meta-analysis aimed to identify whether posterior tilt increases the risk of treatment failure in nondisplaced femoral neck fractures.
Methods
We searched the databases of the PubMed, Embase, and Cochrane Library from 1980 to 2022. The search strategy was based on the combination of keywords “nondisplaced,” “hip fracture,” “femoral neck fracture,” and “internal fixation.” Cohort studies enrolled patients with nondisplaced (Garden I and Garden II) femoral neck fractures were included. Two investigators independently extracted data and the other two assessed the methodological quality. Data were analyzed using Review Manager software.
Results
We analyzed 13 cohort trials with a pooled sample of 4818 patients, with posterior tilt ≥ 20° in 698 patients and < 20° in 3578 patients in 11 trials, and posterior tilt ≥ 10° in 483 patients and < 10° in 496 patients in 4 trials. All studies were of high quality based on Newcastle–Ottawa Scale evaluation. Treatment failure was reported in 24.4% (170/698) of patients with posterior tilt ≥ 20° and 10.9% (392/3578) of patients with posterior tilt < 20°, indicating that posterior tilt ≥ 20° was significantly associated with a higher risk of treatment failure (Risk ratio, 2.73; 95% confidence interval [CI], 1.77–4.21). Posterior tilt ≥ 10° was not found to be a risk factor for fixation failure (risk ratio, 1.92; 95% CI 0.76–4.83).
Conclusion
Nondisplaced femoral neck fractures with posterior tilt ≥ 20° were associated with an increasing rate of failure when treated with internal fixation.
Level of evidence
III, Systematic review and meta-analysis.
中文翻译：
术前后倾可能是非移位股骨颈骨折固定失败的危险因素：系统评价和荟萃分析
目的
这项系统评价和荟萃分析旨在确定后倾斜是否会增加非移位股骨颈骨折治疗失败的风险。
方法
我们检索了 1980 年至 2022 年 PubMed、Embase 和 Cochrane 图书馆的数据库。检索策略基于关键词“非移位”、“髋部骨折”、“股骨颈骨折”和“内固定”的组合。队列研究纳入了非移位（Garden I 和 Garden II）股骨颈骨折患者。两名研究人员独立提取数据，另外两名研究人员评估方法学质量。使用Review Manager 软件分析数据。
结果
我们分析了 13 项队列试验，汇集了 4818 名患者的样本，其中 11 项试验中 698 名患者后倾≥ 20°，3578 名患者后倾 < 20°，483 名患者后倾 ≥ 10°，496 名患者后倾 < 10°。 4次试验。根据纽卡斯尔-渥太华量表评估，所有研究都是高质量的。据报道，后倾斜 ≥ 20° 的患者中有 24.4% (170/698) 治疗失败，后倾斜 < 20° 的患者有 10.9% (392/3578) 治疗失败，表明后倾斜 ≥ 20° 与较高的治疗失败率显着相关。治疗失败的风险（风险比，2.73；95% 置信区间 [CI]，1.77–4.21）。未发现后倾≥ 10°是固定失败的危险因素（风险比，1.92；95% CI 0.76–4.83）。
结论
后倾≥20°的非移位股骨颈骨折与内固定治疗失败率增加相关。
证据级别
III，系统评价和荟萃分析。
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