Bibliographies of all the retrieved articles were hand-searched. The following sources of data were searched up to 1 October 2016 by three reviewers (DFX, CHZ, CHM): EMBASE, PubMed, OVID, Cochrane Library, Web of Science, Scopus, using the search strategy of (((femoral neck fracture ) OR (femoral neck fracture )) AND (“Garden I” OR “Garden II” OR “undisplaced” OR “non-displaced”)) with no limitation on the year or language of publication. The purpose of this systematic review was to assess all available clinical data on outcomes after surgery and conservative therapy to treat undisplaced FNFs we mainly focused on the rates of bone union, secondary displacement, and avascular necrosis (AVN). No difference between conservative and operative treatment was evident in terms of survival rate, outcome score, or patient satisfaction. found that 24 (44%) developed no complications at all during conservative treatment whereas 28 (52%) required surgery because of early fracture dislocation. However, of a total of 54 undisplaced FNF patients, Helbig et al. recommended surgical treatment of undisplaced FNFs this was associated with earlier rehabilitation, lower complication rates, and higher functional scores. The three studies of Bentley et al., Manninger et al., and Cserhati et al. Several retrospective studies have compared surgery and conservative therapy to treat undisplaced FNF. However, up to 22.5% of patients experienced avascular femoral head necrosis after surgery, and a fixation failure problem was also apparent. found that the union rate after surgery was 94.4%. Surgery also seemed to be a good option, reducing secondary displacement and the non-union rate. found that conservative treatment was successful in 85.9% of patients. reported that the secondary displacement rates during conservative therapy were 41 and 33%, respectively. found that conservative therapy afforded an undisplaced FNF union rate of only 44.3%. Patients undergoing conservative treatment enjoyed good outcomes in some studies. However, any surgery is associated with some risk. Surgical treatment was reported to be optimal. The treatment options are conservative (bed rest with or without traction) and surgical (internal fixation). In the Garden classification, Garden I and II fractures describe undisplaced FNFs in older patients. Over 150,000 femoral neck fractures occur every year in the USA, and this number will double by 2050. Surgery to treat undisplaced femoral neck fractures was associated with a higher union rate and a tendency toward less avascular necrosis than conservative treatment.Ī femoral neck fracture (FNF) is one of the most common and devastating injuries encountered by orthopedic surgeons. The avascular necrosis rate in the conservatively treated group was 10.3% (39/380), while it was 7.7% (159/2074) in the surgically treated group ( p = 0.09). Twenty-nine studies involving 5071 patients were ultimately included 1120 patients were treated conservatively and 3951 surgically. We evaluated the quality of each publication and the risk of bias. Statistical analyses were performed with the aid of the chi-squared test. No language or publication year limitation was imposed. We searched the EMBASE, PubMed, OVID, Cochrane Library, Web of Science, and Scopus databases for randomized controlled trials or observational studies that assessed the outcomes of conservative or surgical treatments of undisplaced femoral neck fractures. Herein, we systematically review the rates of union and avascular necrosis after conservative and surgical treatment of undisplaced femoral neck fractures. It remains unclear whether conservative treatment should be used to treat the common undisplaced femoral neck fractures that develop in the elderly.
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