Non-Cochrane · intervention · PM42037933
A Comparison of Internal Fixation and Hemiarthroplasty for Nondisplaced Femoral Neck Fractures: An Updated Systematic Review and Meta-Analysis.
Xamza Mohamed, Jamileh Eyad, Khan Adam, et al. · Cureus · 2026 · PubMed · doi:10.7759/cureus.105817
Findings
Population Older adults (>=65 years) with nondisplaced (Garden I-II) femoral neck fractures
15 findings
| Internal fixation (IF) | Hemiarthroplasty (HA) | Total complications (implant-related and general) Follow-up 24-38 months · Hospital orthopedic surgery | OR 1.73 [1.09, 2.76] GRADE not reported 4 studies · 454 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | All-cause mortality 24 months · Hospital orthopedic surgery | OR 1.17 [0.76, 1.79] GRADE not reported 3 studies · 376 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | All-cause mortality 12 months · Hospital orthopedic surgery | OR 1.17 [0.7, 1.96] GRADE not reported 3 studies · 376 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | Operative time (minutes) Perioperative · Hospital orthopedic surgery | MD -23.07 [-41.14, -4.99] GRADE not reported 4 studies · 454 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | All-cause mortality 36 months · Hospital orthopedic surgery | OR 0.93 [0.5, 1.73] GRADE not reported 2 studies · 157 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | Harris Hip Score (higher is better) 12 months · Hospital orthopedic surgery | MD -2.73 [-6.26, 0.79] GRADE not reported 3 studies · 328 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | Harris Hip Score (higher is better) 24 months · Hospital orthopedic surgery | MD -1.18 [-5.43, 3.06] GRADE not reported 3 studies · 257 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | Deep infection Follow-up 24-38 months · Hospital orthopedic surgery | OR 0.52 [0.14, 1.92] GRADE not reported 4 studies · 454 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | Osteonecrosis Follow-up 24-38 months · Hospital orthopedic surgery | OR 5.97 [1.54, 23.14] GRADE not reported 4 studies · 454 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | Implant-related complications (pooled nonunion/fixation failure, osteonecrosis, deep infection) Follow-up 24-38 months · Hospital orthopedic surgery | OR 4.26 [2.23, 8.11] GRADE not reported 4 studies · 1362 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | All-cause mortality 3 months · Hospital orthopedic surgery | OR 1.29 [0.65, 2.59] GRADE not reported Studies not reported |
| Internal fixation (IF) | Hemiarthroplasty (HA) | Reoperation Follow-up 24-38 months · Hospital orthopedic surgery | OR 4.1 [2.12, 7.95] GRADE not reported 4 studies · 454 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | Harris Hip Score (higher is better) 6 months · Hospital orthopedic surgery | MD -8.06 [-12.45, -3.66] GRADE not reported 2 studies · 169 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | Nonunion and/or fixation failure Follow-up 24-38 months · Hospital orthopedic surgery | OR 13.43 [3.66, 49.33] GRADE not reported 4 studies · 454 participants |
| Internal fixation (IF) | Hemiarthroplasty (HA) | Perioperative blood loss (mL) Perioperative · Hospital orthopedic surgery | MD -143.11 [-204.53, -81.69] GRADE not reported 4 studies · 454 participants |
Included primary studies 8
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Dolatowski 2019 Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in Elderly Patients DOI:10.2106/jbjs.18.00316 | 2019 | this review only | not stated | not extracted yet |
| Dolatowski 2019 Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in Elderly Patients: A Multicenter Randomized Controlled… PMID:30653043 | 2019 | this review only | not stated | not extracted yet |
| Lu 2017 Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized… DOI:10.1007/s00402-016-2591-9 | 2016 | this review only | not stated | not extracted yet |
| Lu 2017 Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized… PMID:27837321 | 2017 | this review only | not stated | not extracted yet |
| Parker 2025 Internal fixation or hemiarthroplasty for undisplaced intracapsular hip fractures: a randomized trial. PMID:40803294 | 2025 | this review only | not stated | not extracted yet |
| Parker and Cawley 2025 Internal fixation or hemiarthroplasty for undisplaced intracapsular hip fractures: a randomized trial DOI:10.52628/91.1.12524 | 2025 | this review only | not stated | not extracted yet |
| Wei 2020 Conservative vs Surgical Treatment of Impacted Femoral Neck Fracture in Patients 75 Years and Older DOI:10.1111/jgs.16535 | 2020 | this review only | not stated | not extracted yet |
| Wei 2020 Conservative vs Surgical Treatment of Impacted Femoral Neck Fracture in Patients 75 Years and Older. PMID:32413174 | 2020 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients aged 65 years or older with nondisplaced (Garden I-II) femoral neck fractures | Elderly patients with nondisplaced femoral neck fractures (n=454) |
| Intervention | Internal fixation | Internal fixation with cannulated or cancellous screws or Targon screws (n=230) |
| Comparison | Hemiarthroplasty | Hemiarthroplasty, cemented or uncemented, bipolar or unipolar (n=224) |
| Outcomes | Implant-related complications (nonunion/fixation failure, osteonecrosis, peri-implant fracture), mortality at 1, 2, 3 years; total complications, reoperation, blood loss, operative time, Harris Hip Score, social independence | Implant-related complications, mortality (3, 12, 24, 36 months), total complications, reoperation, blood loss, operative time, Harris Hip Score (6, 12, 24 months) |
| Study designs | RCTs | RCTs (n=4) |
| Timing | Not specified | Follow-up 24-38 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | No | No | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Partial Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |