Vascularized Bone Grafting In The Treatment Of Femoral Neck Fractures In Young Adults To Prevent Fracture Nonunion And Avascular Necrosis Of The Femoral Head In Early Stage:a Systematic ReVIEW

Background:Nonunion and avascular necrosis (AVN) are two main complications of the femoral neck fractures in young adults, which are always the problems confronted by orthopedist. In recent years some literatures reported vascularized bone grafting in the treatment of femoral neck fractures in young adults to prevent the nonunion of fracture and avascular necrosis of the femoral head in early stage. However, it’s still controversial whether the vascularized bone grafting can decrease the occurrence of nonunion and avascular necrosis of the femoral head when combined with the internal fixation procedure, for currently, most operations are performed with simple reduction and internal fixation.Objective:To review literatures about operative treatments of the femoral neck fractures in young adults (age15-60years), compare difference of the nonunion rate and AVN rate after treatment with internal fixation combined with or without vascularized bone grafting by meta analysis, in order to determine whether the vascularized bone grafting is necessary.Methods:To search Pubmed, The Cochrane Library, EMBASE and CNKI,Wangfang,VIP for collecting the literatures about comparison study of internal fixation with or without vascularized bone grafting in the treatment of femoral neck fractures in young adults, and the outcomes of nonunion rate and AVN rate were extracted from eligible studies. Meta analyses were performed by the RevMan5.2software.Result:20studies involving1813femoral neck fractures in young adults were used for meta analysis. The results showed that compared with the simple internal fixation, internal fixation combined with vascularized bone grafting resulted in lower nonunion rate[RR=0.24,95%CI(0.16,0.37), p<0.05], lower AVNrate[RR=0.29,95%CI (0.21,0.40), p<0.05], and a higher excellent and good rate of the function of hip joint[OR=4.20,95%CI (2.85,6.18), p <0.05]. Based on GRADE system, the evidences were at level B and the recommendation was weak(2B).Conclusion:The internal fixation combined with vascularized bone grafting resulted in a lower nonunion rate and a lower AVN rate and a higher excellent and good rate of the function of hip joint than simple internal fixation in the treatment of femoral neck fractures in young adults.