Objective: To compare the effectiveness of the medial support plate combined with three cannulated screws versus simple three cannulated screws in treating Pauwels type Ⅲ femoral neck fracture in young adults through Meta-analysis. Methods: A search was conducted across various databases including CNKI, Wanfang, VIP, PubMed, Cochrane Library, and Web of Science(WOS) to find randomized controlled trials, cohort studies, and other literature related to the treatment of Pauwels type Ⅲ femoral neck fracture using medial support plate combined with three cannulated screws or simple three cannulated screws. The search period covered the time from the inception of the database to June 2023. The screening, quality evaluation, data extraction, and other tasks were performed independently by two individuals based on established inclusion criterias. At last, Stata 14 and stata 17 were used for Meta-analysis. Results: Twenty articles were included comprising a total of 1 294 patients. The Meta-analysis showed that the operation time was longer(MD=26.52,95% CI 20.99-31.50, P＜0.001) and intraoperative blood loss was more(MD=89.68,95% CI 70.95-107.42,P＜0.001) in the medial support plate combined with three cannulated screws group than those in the simple three cannulated screws group. The incidence of reduction quality for acceptable(RR=0.32, 95% CI 0.17-0.58, P＜0.001) and poor(RR=0.17, 95% CI 0.06-0.45, P＜0.001) was lower than those of the simple three cannulated screws group. The time of healing fractures was significantly reduced(MD=1.05, 95%CI-1.34 –-0.67, P＜0.001) in patients in the medial support plate combined with three cannulated screws group. Additionally, the quality of the reduction for perfect(RR=1.57, 95%CI 1.35-1.83, P＜0.001) was higher, and the total number of postoperative complications was lower(RR=0.31, 95%CI 0.24-0.40, P＜0.001), and the incidence of femoral head necrosis was reduced(RR=0.43, 95%CI 0.08-1.80, P＜0.001) in the medial support plate combined with three cannulated screws group. Moreover, the rate of fracture nonunion was lower(MD=0.38, 95%CI 0.28-0.67, P＜0.001), and the Harris scores at 1 month, 3 months, 6 months, and 12 months after the operation were better in the medical support plate combined with three cannulated screws group than those of the simple three cannulated screws group. There was no significant difference between the two groups in the reduction quality for good, postoperative infection, and delayed fracture healing. Conclusion: The use of three cannulated screws along with a medial support plate can be effective in treating Pauwels type Ⅲ femoral neck fractures. This method can result in better fracture reduction, fewer postoperative complications, and improved functional scores for patients after operation. However, the operation time is longer and intraoperative blood loss is higher compared to the simple three cannulated screws group. |
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