A Meta Analysis Of Internal Fixation Compared With Arthroplasty For Displaced Fractures Of The Femoral Neck In Aged Patients

Objective:to assess the effect of arthroplasty(unipolar,bipolar arthroplasty and total hip arthroplasty) compared with that of internal fixation,on rates of mortality,revision,main postoperative complications,operate time,blood loss in aged patients with a displaced femoral neck fractureMethods: A meta analysis of all relevant randomized controlled trials(RCTs)was performed.We included RCTs in patients with femoral neck fracture to compared internal fixation and arthroplastyResult:First we identified 92 papers on comparison of internal fixation with arthroplasty in the treatment of femoral neck fracture pubilished from 1950 to 2007.Sixteen trials involving 2697 patients were identified as meeting all the eligibility criteria .Thirteen trials,which included a total of 2098 patients,provided information on mortlity rates over the first six postoperative months.We found no significant difference in the risk of death in the first six months after arthroplasty compared with that after internal fixation(relative risk 0.93).The similar situation happened in one and three years postoperatively. Fifteen trials,which included a total of 2276 and 2399 patients,provided information on main complication(31.8% vs 10.4%,RR 2.94) and reoperation(35.4% vs 7.7%,RR 4.91) .Primary athroplasty lead to significantly fewer major complication and reoperation,compared with internal fixation.There is absolutely greater blood loss and longer operative times in arthroplasty.Conclution:On treatment of displaced femoral neck fracture,arthroplasty significantly reduces the risk of major complication and reoperation at the cost of great blood loss and operative time ,compared to internal fixation and show better function and pain relief postoperatively. There is no significant difference in postoperative mortality.