Efficacy of internal fixation alone versus combined pedicled bone grafting in young people with fresh Garden type III/IV femoral neck fracture: a systematic review and meta-analysis.

BACKGROUND

This systematic review synthesizes current evidence on the efficacy of internal fixation combined with pedicled bone grafting (IFPBG) for treating fresh Garden type III/IV femoral neck fractures in young people.

METHODS

Registered prospectively in PROSPERO (CRD42024584036), we systematically searched PubMed, EMBASE, Web of Science and Cochrane Library databases from inception through August 20, 2024. Two reviewers independently performed data extraction and assessed methodological quality using the Institute of Health Economics appraisal checklist. Treatment outcomes and complications were analyzed through pooled rate calculations and odds ratio (OR) comparisons.

RESULTS

Three studies involving 353 patients met inclusion criteria, demonstrating generally robust methodological quality. The IFPBG group (Group A) showed superior fracture healing rates compared to internal fixation alone (Group B) (91.7% vs 67.7%; χ = 23.332, p < 0.001), with significant between-group differences in healing likelihood (OR = 5.53, 95%CI[2.98-10.28], p < 0.00001; I = 0%). Group A also demonstrated statistically lower risks of avascular necrosis (AVN) (OR = 0.22, 95%CI[0.10-0.46], p < 0.0001) and nonunion (OR = 0.22, 95%CI[0.09-0.57], p = 0.002). No intergroup differences emerged in wound infection or deep vein thrombosis rates.

CONCLUSIONS

Current evidence suggests IFPBG enhances fracture healing while reducing AVN and nonunion risks in young patients with displaced femoral neck fractures. Notwithstanding inherent limitations in included studies, these findings support further controlled trials to validate the therapeutic value of adjunctive pedicled bone grafting.