Why use cannulated screws

For retrospective cohort studies, three studies had 9 scores [ 9 , 10 , 28 ], two studies had 8 scores [ 15 , 19 ], and two studies had 7 scores [ 16 , 22 ]. The details were shown in Fig. Mortality at the last follow-up was reported in six studies [ 9 , 10 , 17 , 23 , 26 , 27 ] including hips for DHS and for CS. Thirteen studies [ 9 , 10 , 15 , 17 , 18 , 19 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] enrolled hips for DHS and for CS which reported the non-union rate.

In our meta-analysis, we found that a study by Hoshino [ 19 ] is different from other included studies. The hips included in DHS treatment are more than three times to CS treatment, and only 15 hips were analyzed in the CS group, which would lead to selection bias. After this study removed, a sensitive meta-analysis was conducted.

Forest plot of odds ratio with confidence intervals for AVN. Fourteen studies [ 9 , 10 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] including hips compared the revision rate between DHS and CS treatments. Revision rate enrolled most of included sixteen studies, so publication was performed for revision rate.

We found that the triangle is basically symmetrical, and no obvious publication bias existed Fig. Due to the anatomical and blood supply characteristics of femoral neck and femoral head, the incidence of complications and disability after femoral neck fracture surgery are relatively high [ 29 , 30 ]. Internal fixation is less invasive and cheaper, could also protect femoral head, and delay the need for future arthroplasty, so DHS or CS is commonly used for femoral neck fractures in young patients and some elderly patients [ 31 ].

In this study, we performed a meta-analysis to compare the complications between DHS and CS for the treatment of femoral neck fractures. Compared with previous systematic reviews, our study has some advantages. First, some latest studies [ 10 , 15 , 18 ] were not enrolled for analysis in previous study. Compared with previous studies [ 8 , 11 , 32 ], our study has a larger sample size, and sixteen trials in total were enrolled, which provided more strong evidence for surgeon.

Third, the complications were divided into mortality, re-invention or revision, non-union, and AVN, which provided more guidance for surgeons involved in these procedures unlike that in the study by Zhang et al.

In Zhang et al. However, AVN and non-union are obviously different and critical adverse events, and a subgroup and sensitive analysis is necessary. Our findings were basically consistent with current trends. We considered that the reason for the larger range may be due to the difference in sample size and follow-up time. However, we also have some different findings. In our meta-analysis, a study by Hoshino et al.

We consider that the main reason for this is the advantage of expanded sample size, and two large sample studies support our point of view [ 10 , 17 ]. We considered that the lower AVN rate in CS group was related to less invasive, which protected the blood supply as much as possible [ 6 , 8 ]. In addition, the incidence rate of AVN would be significantly different and depend on displacement of the femoral neck at the time of the injury, and the AVN in displaced fracture was obvious higher than that in the non-displaced fracture [ 15 ].

For another outcome, revision was defined as any reason that required internal fixation, hemiarthroplasty, or total hip replacement THA. Previous studies used reoperation rate for analysis; however, reoperation includes various reasons such as infection and other factors requiring reoperation.

Mohamed et al. However, we found that a study [ 34 ] included by Zhang et al. Limitations were also existed in our study. First, non-English language studies as well as studies that could not obtain full text were not included in this meta-analysis, which could lead to selection bias.

Second, previous study reported DHS and CS were also different for displaced and non-displaced fractures. The DHS has slight advantages for the management for displaced femoral neck fractures. Third, the treatment methods of CS group were not completely consistent, some are two cannulated screws and some are three cannulated screws, which might have unpredictable bias.

Forth, the age and fracture type could affect the mortality and development of AVN, respectively. However, many studies included in this meta-analysis include all ages and different fracture types displaced and non-displaced hips. In a word, further analysis is required to provide stronger evidence for clinical treatment. In future, more and more study needed to provide strong evidence because of some limitation existed in this study.

Epidemiology of fractures in 15, adults: the influence of age and gender. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. Dickson JA. The unsolved fracture; a protest against defeatism. J Bone Joint Surg Am. Subtrochanteric fracture: a rare but severe complication after screw fixation of femoral neck fractures in the elderly.

Acta Orthop Belg. PubMed Google Scholar. Complications of femoral neck fracture in young adults. J Trauma. Using a cannulated screw as a drill guide and sleeve: a simple technique for multiple-screw fixation for intracapsular femoral neck fracture. Google Scholar. Brandt E, Verdonschot N.

Biomechanical analysis of the sliding hip screw, cannulated screws and Targon1 FN in intracapsular hip fractures in cadaver femora.

Article Google Scholar. Multiple cannulated screws vs. Der Orthopade. Surgical treatment of undisplaced femoral neck fractures in the elderly. Int Orthop. J Clin Med. Sliding hip screws versus cancellous screws for femoral neck fractures: a systematic review and meta-analysis.

Eur J Orthop Surg Traumatol. Int J Surg London, England. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Results of cannulated screw fixation. Femoral neck fractures in skeletally mature patients, fifty years old or less.

A Meta-Analysis. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. Bone grafting in femoral neck fractures: results in 28 cases operated on with multiple pinning and cancellous bone grafting. Feinblatt highlights his technique for installation of parallel 4. Cancellous thread form Designed to reduce possibility of soft tissue irritation when compared with standard screw heads. Fully threaded screws Intended to be used to stabilize fractures with little to no compression across the fracture.

Low-profile head Designed to reduce possibility of soft tissue irritation when compared with standard screw heads. Partially threaded screws May be used to lag one bone fragment to another, where the far bone fragment is captured by the threads of the screw and pulled towards the near cortex fragment on the head side of the screw.

Reverse cutting flutes Designed to assist in removal of partially threaded screws. Self-drilling and self-tapping screw tip Designed to facilitate insertion and may eliminate the need for predrilling and tapping in some cases.

Product Overview The Acumed Cannulated Screw System consists of screws, washers, and instruments designed to provide fixation for fractures, fusions, and osteotomies of large and small bones appropriate for the size of the device. Related Documents. Screw System Features. Wide range of screw lengths address a variety of fracture patterns Reverse cutting flutes are designed to assist in the removal of partially threaded screws not included on some short thread 4.

Locking Flip-Up Caddy Contains core implantation instruments in an upright orientation with integrated locking feature designed for maximum stability on the back table. Implantation instruments shown in the upright position. Integrated metal locking feature automatically engages when the caddy is in the upright position.

Parallel Wire Guide Allows placement of two parallel wires. The Acumed 4. The system consists of screws, washers, and instruments designed to provide fixation for fractures, fusions, and osteotomies of large and small bones appropriate for the size of the device.