Meta analysis of different methods used for joint preserving procedures in the management of delayed, neglected and non-united femoral neck fractures in young adults

Abstract

Background Neglected fractures in young adults can be amongst the most difficult to treat in the spectrum of fractures of the femoral neck. Because of its complex anatomy and blood supply, timely fixation is paramount. When this does not occur, non-union and avascular necrosis are common complications. Here, we present a meta-analysis of three common options available to the surgeon treating such complications. Methods We identified 97 relevant papers by the keywords ‘femoral neck fractures’; ‘neglected’; ‘joint preserving’ and ‘young adults’; 23 met the inclusion criteria and reported on an overall population of 725 patients. Results Osteotomy with internal fixation had a union rate of 91.33% (95% CI 84.91–92.87). Fractures fixed by internal fixation with pedicled muscle graft proceeded to union in 86.25% (95% CI 78.92%–88.54%) of cases and those managed with free fibular graft in 88% (95% CI 78.35%–90.84%), respectively. Internal fixation alone, in this study, used as an illustrative control group, was successful in 76.5% (95% CI 65.58%–83.81%) of cases. Conclusion These findings show superiority of osteotomy with internal fixation in the management of non-united femoral neck fractures, and more complex options with potentially higher morbidity confer no patient benefit.