Internal Fixation Compared With Arthroplasty For Displaced Fractures Of The Femoral Neck In The Elderly: A Systematic Review

Objective:To evaluate the efficacy and safety of Internal fixation(IF) and arthroplasty for displaced fractures of the femoral neck in the elderly.Methods:A computerized search of articles published from January 1979 to May 2009 was performed using MEDLINE,EMBASE and Chinese Biomedicine Database(CBM). Additionally, a search from the Cochrane Library (Issue 1,2009) was performed to identify studies comparing the results of arthroplasty and IF for displaced fractures of thefemoral neck in the elderly(>60years old). The quality of included studies was critically assessed and data analyses were performed with Cochrane Collaboration's RevMan 5.0Results:13 literatures of 11 studies included a total of 2,339 patients were included,all of which are randomized controlled trials (RCT). Meta-analyses showed that there was no significant difference in comparison of arthroplasty with IF about the mortality at 4-6 months,1 year,2 years postoperatively [RR=1.11,95%CI(0.88,1.40),P=0.38],[RR=1.02,95%CI(0.87,1.19),P=0.83] and [RR=0.96,95%CI(0.78,1.19),P=0.73].Compared with IF,arthroplasty took longer operating time[WMD=33.4,95%CI为(21.71,45.09),] and involved greater blood loss[WMD=304.29,95%CI为(169.92,438.65),P<0.01],but it led to significantly fewer complications [RR=0.32,95%CI(0.19,0.55), P<0.01] and reduced the incidence of reoperation[RR=0.28,95%CI(0.19,0.42), P<0.01].Conclusions:Compared with internal fixation,arthroplasty could reduced the incidence of reoperation and the complications,but it took longer operating time and involved greater blood loss.There was no difference for the mortality.