Postoperative complications following open reduction and internal fixation combined with vascularized bone flap graft versus only reduction and internal fixation for femoral neck fractures: a systematic review

Objective To systematically evaluate the postoperative complications following open reduction and internal fixation combined with vascularized bone flap graft versus only reduction and internal fixation for femoral neck fractures. Methods CNKI, Wan Fang Chinese database, Pubmed, EMBASE and Google Scholar English database were searched for the randomized controlled trials from January 1, 2000 through October 31, 2017 which compared open reduction and internal fixation combined with vascularized bone flap graft (combined surgery group) with only reduction and internal fixation (simple surgery group) for femoral neck fractures. The data concerning postoperative nonunion and avascular necrosis of the femoral head were extracted. The 2 surgical treatments of the patients with femoral neck fracture were compared in terms of the 2 complications. Statistical analyses were conducted using software Stata 12 by relative risk (RR) and corresponding 95% confidence intervals (95%CI). Results According to our inclusion and exclusion criteria, a total of 23 studies were included, involving 2,162 cases (1,048 cases receiving combined surgery and 1,114 cases simple surgery). The Meta analyses showed that the fracture nonunion rate for the combined surgery group was significantly lower than that for the simple surgery group [RR=0.27, 95%CI(0.19, 0.38), P<0.001] and the rate of avascular necrosis was also significantly lower for the former than for the latter [RR=0.31, 95%CI(0.24, 0.42), P<0.001]. Conclusion In the treatment of femoral neck fractures, open reduction and internal fixation combined with vascularied bone graft may lead to lower rates of nonunion and avascular necrosis of the femoral head than simple open reduction and internal fixation. Key words: Femoral neck fractures; Fracture fixation, internal; Fractures, ununited; Femur head necrosis; Meta-analysis