J Orthop Trauma. 2022 Sep 23. doi: 10.1097/BOT.0000000000002490. Online ahead of print.
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the posterior tilt angle (PTA) in predicting treatment failure after internal fixation of nondisplaced femoral neck fractures as graded by the Garden classification, which is based solely on anterior-posterior radiographic evaluation.
DATA SOURCES: A search was conducted of all published literature in the following databases from inception to December 20, 2021: PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov.
STUDY SELECTION: We included English-language randomized controlled trials, prospective and retrospective cohort studies that reported malunion/nonunion, avascular necrosis, fixation failure, or reoperations in patients with nondisplaced femoral neck fractures treated with internal fixation who were evaluated for PTA using either lateral radiograph or computed tomography (CT).
DATA EXTRACTION: All abstract, screening, and quality appraisal was conducted independently by two authors. Data from included studies was extracted manually and summarized. The Methodological Index for Non-Randomized Studies criteria was used for quality appraisal.
DATA SYNTHESIS: Odds ratios (OR) with 95% confidence intervals (CI) were calculated for treatment failure, defined as nonunion/malunion, AVN, fixation failure, or reoperation, in cases involving preoperative PTA ≥20 degrees and <20 degrees. Statistical significance was set at p<0.05.
RESULTS: Nondisplaced femoral fractures with PTA>20 degrees had a 24% rate of treatment failure compared to 12% for those <20 degrees (OR, 3.21 [95% CI, 1.95-5.28]; p<0.001).
CONCLUSION: PTA is a predictor of treatment failure in nondisplaced femoral neck fractures treated with internal fixation. Nondisplaced femoral neck fractures with a PTA >20 degrees may warrant alternative treatment modalities.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.