Sprague Sheila, Slobogean Gerard P, Scott Taryn, Chahal Manraj, Bhandari Mohit
Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatics, McMaster University, Hamilton, ON, Canada.
Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
Injury. 2015 Mar;46(3):507-14. doi: 10.1016/j.injury.2014.11.020. Epub 2014 Nov 27.
Femoral neck fractures in younger aged patients are particularly devastating injuries with profound impairments of quality of life and function. As there are multiple differences in patient and injury characteristics between young and elderly femoral neck fracture patients, the geriatric hip fracture literature is unlikely to be generalisable to patients under age 60. We conducted a systematic review to determine if clinically relevant outcome measures have been used in previously published clinical studies of internal fixation in young adults with femoral neck fractures.
We conducted a comprehensive literature search using multiple electronic databases and conference proceedings to identify studies which used internal fixation for the management of femoral neck fractures in patients between the ages of 15 to 60. Eligibility screening and data abstraction were performed in duplicate. We classified the reported outcomes into the following categories: operative and hospital outcomes, radiographic outcomes, clinical outcomes, and functional outcomes and health-related quality of life. We calculated the frequencies of reported outcomes.
Fort-two studies met our inclusion criteria. Operative and hospital outcomes were poorly reported with less than one-quarter of studies reporting relevant data. Important radiographic outcomes were also inadequately reported with only one-third of studies reporting the quality of the fracture reduction, and methods for assessment were highly variable. The assessment of avascular necrosis was reported in almost all the included studies (95.2%); however, the assessment of nonunion was only reported in three-quarters of the studies. Re-operations were reported in 73.8% of the included studies and the assessment of fracture healing was only reported in two-thirds of the studies. Less than half of the studies reported functional outcomes or health-related quality of life (overall patient evaluation scales and systems (45.2%), patient functional outcomes (30.9%), and health-related quality of life (4.8%).
Our systematic review found that the assessment of clinically relevant outcomes in the young femoral neck fracture literature is lacking, which makes utilising the literature to guide clinical practice challenging. Future studies should aim to include important radiographic measures, fracture-healing complications, functional outcomes, and health-related quality of life during any assessment of young femoral neck fracture treatment.
年轻患者的股骨颈骨折是极具破坏性的损伤，会严重损害生活质量和功能。由于年轻和老年股骨颈骨折患者在患者及损伤特征方面存在诸多差异，老年髋部骨折的文献不太可能适用于60岁以下的患者。我们进行了一项系统综述，以确定在先前发表的关于年轻成人股骨颈骨折内固定的临床研究中是否使用了具有临床相关性的结局指标。
我们使用多个电子数据库和会议论文集进行了全面的文献检索，以识别使用内固定治疗15至60岁患者股骨颈骨折的研究。资格筛选和数据提取由两人独立进行。我们将报告的结局分为以下几类：手术和住院结局、影像学结局、临床结局、功能结局以及与健康相关的生活质量。我们计算了报告结局的频率。
42项研究符合我们的纳入标准。手术和住院结局报告不佳，不到四分之一的研究报告了相关数据。重要的影像学结局报告也不充分，只有三分之一的研究报告了骨折复位质量，且评估方法差异很大。几乎所有纳入研究（95.2%）都报告了缺血性坏死的评估；然而，只有四分之三的研究报告了骨不连的评估。73.8%的纳入研究报告了再次手术情况，只有三分之二的研究报告了骨折愈合情况。不到一半的研究报告了功能结局或与健康相关的生活质量（总体患者评估量表和系统（45.2%）、患者功能结局（30.9%）以及与健康相关的生活质量（4.8%））。
我们的系统综述发现，年轻股骨颈骨折文献中缺乏对具有临床相关性结局的评估，这使得利用该文献指导临床实践具有挑战性。未来的研究应旨在在任何年轻股骨颈骨折治疗评估中纳入重要的影像学指标、骨折愈合并发症、功能结局以及与健康相关的生活质量。
