Systematic review and meta-analysis evaluates femoral neck system versus cannulated screws for Pauwels type III fractures.
Photo by Rohit Choudhari / Unsplash
Key Takeaway
Consider FNS for Pauwels type III fractures in non-elderly adults, noting improved healing but increased blood loss.
This publication is a systematic review and meta-analysis comparing the Femoral Neck System (FNS) to cannulated screws (CS) for Pauwels type III femoral neck fractures. The analysis included data from 557 non-elderly adults. The primary outcome assessed was fracture healing time, while secondary outcomes included weight-bearing time, postoperative complications, and Harris Hip Score (HHS).
Regarding fracture healing time, the FNS performed significantly better than CS, with a standard mean difference of -0.90 and a 95% confidence interval of (-1.30, -0.49). The review also reported earlier mobilization and superior hip function with FNS. Additionally, postoperative complications were fewer in the FNS group compared to the CS group.
Safety findings highlighted increased intraoperative blood loss with FNS compared to CS. Serious adverse events and discontinuations were not reported in the available data. The authors noted that while FNS showed benefits in healing and function, the trade-off involves blood loss management.
The practice relevance suggests FNS may be a more effective and safer fixation option for Pauwels type III femoral neck fractures in non-elderly adults. Clinicians should weigh the improved healing outcomes against the potential for increased blood loss during surgery. Further research is needed to confirm long-term safety profiles given the current limitations in reported adverse events.
View Original Abstract ↓
The optimal fixation strategy for Pauwels type III femoral neck fractures in non-elderly adults remains controversial because of the high risk of postoperative complications. The femoral neck system (FNS) has been developed to improve angular and rotational stability, but its clinical advantages over cannulated screws (CS) in this unstable fracture pattern remain unclear. This study aimed to compare the safety and effectiveness of FNS and CS in non-elderly patients with Pauwels type III femoral neck fractures.
A systematic search of PubMed, Embase, Web of Science, the Cochrane Library, Scopus, the Korean database (RISS), and Chinese databases (CNKI and Wanfang) was conducted to identify comparative studies evaluating FNS vs. CS in non-elderly adults with Pauwels type III femoral neck fractures. Fracture healing time, weight-bearing time, postoperative complications, and Harris Hip Score (HHS) were analyzed. Pooled results were expressed as mean differences (MD), standard mean differences (SMD), or odds ratios (OR) with 95% confidence intervals (CI). Meta-analyses were performed using RevMan 5.4.
A total of ten studies were included, with a collective count of 557 non-elderly patients suffering from Pauwels type III femoral neck fractures. Among these patients, 276 patients underwent FNS treatment, whereas 281 patients were treated with CS. The findings indicated that FNS performed significantly better than did CS in terms of fracture healing time [standard mean difference (SMD) = −0.90; 95% CI (−1.30, −0.49); P
Despite increased intraoperative blood loss, FNS was associated with faster fracture healing, earlier mobilization, fewer postoperative complications, and superior hip function compared with CS. These findings suggest that FNS may be a more effective and safer fixation option for Pauwels type III femoral neck fractures in non-elderly adults.
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251111561, PROSPERO CRD420251111561.
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