Introduction
Materials and methods
Literature search
Methodological quality of studies
Sample Size | ||||||||||
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Study | Study Design | Implant | Total | AR | PBR | NBR | Age | Female Sex | Included Fracture Type | Follow-Up (months) |
Ding et al.(2016) | RCS | CS | 117 | 40 | 39 | 38 | ≤ 65 | - | 22.4 | |
Lu et al.(2017) | 105 | 35 | 35 | 35 | 30 (29%) | Garden I-IV | 12 | |||
Tian et al.(2018) | 96 | 48 | 48 | 0 | 34 (35%) | 36 | ||||
Xiong WF et al.(2019) | 46 | 30 | 16 | 0 | 20 (43%) | 22 | ||||
Huang K et al.(2020) | 67 | 21 | 24 | 22 | 28 (42%) | 22.5 | ||||
Zhao et al.(2021) | 222 | 82 | 78 | 62 | 90 (40%) | Garden I-IV、Pauwels I-III | 49.4 | |||
Zhao GL et al.(2021) | 110 | 41 | 35 | 34 | 48 (44%) | Garden I-IV、Pauwels I-III | 27 | |||
Yang et al.(2023) | 74 | 28 | 25 | 21 | 38 (51%) | Garden I-IV | 21.8 | |||
Zhu J et al.(2022) | DHS + DS | 68 | 37 | 31 | 0 | 24 (35%) | Garden III/IV、Pauwels II/III | 51.7 | ||
LI et al.(2022) | PCS | PCCP | 69 | 23 | 23 | 23 | 22 (32%) | Garden I-IV | 12 | |
Jiang QL et al.(2023) | RCS | FNS | 58 | 21 | 19 | 18 | 27 (47%) | Garden I-IV、Pauwels I-III | 18.6 | |
Total | 1032 | 406 | 373 | 253 |
Results
Characteristics of the studies
Study | Harris hip score (follow up 1 year) | Femoral head necrosis | Shortening (> 5 mm) or Displacement to varus (> 10°) | Fracture nonunion | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
AR | PBR | NBR | AR | PBR | NBR | AR | PBR | NBR | AR | PBR | NBR | |
Ding et al.(2016) | 84.5 | 86 | 78.9 | 15.0% | 15.4% | 18.4% | 7.5% | 7.7% | 26.8% | NS | ||
Lu et al.(2017) | 86.2 | 86.2 | 76.9 | 11.0% | 11.0% | 14.3% | 14.2% | 8.7% | 25.7% | NS | ||
Xiong WF et al.(2019) | NS | 3.3% | 0 | - | 10.0% | 6.4 | - | 6.7% | 3.3% | - | ||
Huang K et al.(2020) | 85.6 | 84.5 | 74.3 | 19.1% | 20.8% | 22.7% | 23.8% | 41.7% | 50.0% | NS | ||
Zhao et al.(2021) | 85.9 | 85.4 | 81.9 | 13.4% | 5.4% | 32.2% | 3.7% | 5.1% | 14.5% | 3.7% | 2.6% | 12.9% |
Zhao GL et al.(2021) | NS | 12.2% | 11.4% | 20.6% | 12.2%/4.9% | 11.4%/5.7% | 32.4%/11.8% | 4.9% | 2.9% | 5.9% | ||
Yang et al.(2023) | 88.8 | 88.1 | 83.3 | 3.6% | 4.0% | 19.0% | 21.4% | 28% | 66.7% | NS | ||
Jiang QL et al.(2023) | 85.9 | 86.2 | 85.2 | 4.8% | 5.3% | 25.0% | 9.5% | 5.3% | 16.7% | NS | ||
Harris hip score ( good excellent rate) | ||||||||||||
Tian et al.(2018) | 89.6% | 93.8% | - | 16.7% | 4.17% | - | NS | 4.2% | 0% | - | ||
Zhu J et al.(2022) | 64.8% | 83.9% | - | 10.8% | 6.5% | - | PBR was lower than AR | 5.4% | 0% | - | ||
LI et al.(2022) | 100% | 95.7% | 64.3% | 13.0% | 8.7% | 8.7% | 13.04% | 8.7% | 39.1% | 4.4% | 8.7% | 8.7% |
Study | Implant | Fracture Type | Model Classification | The Peak displacement | The Peak Stress | |
---|---|---|---|---|---|---|
2017 Zheng | PHN | Pauwels type III(70°) | 4 Models (PBR and NBR under two loading conditions imulating “stance” and“walking” respectively) | The fracture end under “stance” conditions: 0.87 mm (PBR) and 1.38 mm (NBR), “walking” conditions:1.98 mm (PBR) and 1.27 mm(NBR) | The implants under“stance”conditions: 304.47 MPa (PBR) and 359.03 MPa (NBR),“walking”conditions:362.24 MPa (PBR) and 391.52 MPa (NBR) | |
2021 Zhao | CS | Pauwels type II(50°) | 3 Models(AR、PBR、NBR) | The average displacement of fracture end: PBR < NBR | The mean stress of the calcar: PBR < NBR | |
2019 Wang | CS | Pauwels type I(30°) | 5 Models (AR、PBR(2、3、4 mm) and NBR) | The fracture end: 0.547 mm(PBR 2 mm)、0.721 mm (PBR 3 mm) 、0.838 mm (PBR 4 mm) 、0.388 mm (AR) and 0.786 mm (NBR 2 mm) | The implants: 358.2Mpa (PBR 2 mm)、526.4Mpa (PBR 3 mm)、916.1Mpa (PBR 4 mm)、261.2Mpa (AR) and 705.8Mpa (NBR 2 mm) | |
2022 Zhu | DHS + DS | Pauwels type III(> 70°) | 2 Models (AR、PBR) | The fracture end: PBR < AR | The implants: 360 MPa(PBR) < 515 MPa(AR) | |
2023 Fan Z | FNS | Pauwels type I(30°) | Total:18 | 9 Models: AR PBR(1、2、3、4 mm) NBR(1、2、3、4 mm) | 1、The implants: 2.231 mm(AR) 2.229 mm(PBR 1 mm)、2.227 mm (PBR 2 mm) 、2.225 mm (PBR 3 mm) 、2.227 mm (PBR 4 mm) 、 2.233 mm(NBR 1 mm)、2.235 mm (NBR 2 mm) 、2.236 mm (NBR 3 mm) 、2.237 mm (NBR 4 mm) 。 2、The femur: 2.67 mm(AR) 2.466 mm(PBR 1 mm)、 2.466mma (PBR 2 mm) 、2.467 mm (PBR 3 mm) 、2.473 mm (PBR 4 mm) 、 2.467 mm(NBR 1 mm)、2.467 mm (NBR 2 mm) 、2.467 mm (NBR 3 mm) 、 2.466 mm (NBR 4 mm) 。 | 1、The implants: 432.4 MPa(AR) 430.7 MPa(PBR 1 mm)、429.7 MPa (PBR 2 mm) 、542.4 MPa (PBR 3 mm) 、536.3 MPa (PBR 4 mm) 、 801.6Mpa(NBR 1 mm)、800.3Mpa (NBR 2 mm) 、540.5Mpa (NBR 3 mm) 、539.1Mpa (NBR 4 mm) 。 2、The femur: 85.97 MPa(AR) 89.51 MPa(PBR 1 mm)、94.57 MPa (PBR 2 mm) 、88.75 MPa (PBR 3 mm) 、76.44 MPa (PBR 4 mm) 、 89.11Mpa(NBR 1 mm)、89.45Mpa (NBR 2 mm) 、 89.38Mpa(NBR 3 mm)、88.56Mpa (NBR 4 mm) 。 |
2023 Fan Z | FNS | Pauwels type II(50°) | Total:18 | 9 Models: AR PBR(1、2、3、4 mm) NBR(1、2、3、4 mm) | 1、The implants: 2.288 mm(AR) 2.302 mm(PBR 1 mm)、2.340 mm (PBR 2 mm) 、 2.390 mm(PBR 3 mm)、2.415 mm (PBR 4 mm) 、 2.286 mm(NBR 1 mm)、2.293 mm (NBR 2 mm) 、 2.320 mm(NBR 3 mm)、2.335 mm (NBR 4 mm) 。 2、The femur: 2.533 mm(AR) 2.562 mm(PBR 1 mm)、2.621 mm (PBR 2 mm) 、 2.693 mm(PBR 3 mm)、2.736 mm (PBR 4 mm) 、 2.520 mm(NBR 1 mm)、2.518 mm (NBR 2 mm) 、 2.543 mm(NBR 3 mm)、2.552 mm (NBR 4 mm) 。 | 1、The implants: 514.6 MPa(AR) 685 MPa(PBR 1 mm)、757.7 MPa (PBR 2 mm) 、 843.5 MPa(PBR 3 mm)、880.4 MPa (PBR 4 mm) 、 660.4Mpa(NBR 1 mm)、678.1Mpa (NBR 2 mm) 、 730.9Mpa(NBR 3 mm)、759.2Mpa (NBR 4 mm) 。 2、The femur: 95.63 MPa(AR) 114.6 MPa(PBR 1 mm)、126.1 MPa (PBR 2 mm) 、 99.94 MPa(PBR 3 mm)、88.89 MPa (PBR 4 mm) 、 86.83Mpa(NBR 1 mm)、247.7Mpa (NBR 2 mm) 、 184.6Mpa(NBR 3 mm)、182.5Mpa (NBR 4 mm) 。 |
2023 Jia | FNS | Pauwels type I(30°) | Total:9 | 3 Models (AR、PBR(2 mm)、NBR(2 mm)) | 1、The implants: 1.1324 mm(PBR 2 mm)、 1.1712 mm(AR)and 1.220 mm (NBR 2 mm) 2、The femur: 1.2881 mm(PBR 2 mm)、 1.3387 mm(AR)and 1.4052 mm (NBR 2 mm) | 1、The implants: 286.66Mpa(PBR 2 mm)、 323.98Mpa(AR)and 374.58Mpa (NBR 2 mm) 2、The femur: 64.07Mpa(PBR 2 mm)、 65.485Mpa(AR)and 79.271Mpa (NBR 2 mm) |
Pauwels type II(50°) | 3 Models (AR、PBR(2 mm)、NBR(2 mm)) | 1、The implants: 1.1485 mm(PBR 2 mm)、1.1712 mm (AR) and 1.1746 mm (NBR 2 mm) 2、The femur: 1.312 mm(PBR 2 mm)、1.3355 mm (AR) and 1.4068 mm (NBR 2 mm) | 1、The implants: 303.56Mpa(PBR 2 mm)、328.05Mpa (AR) and 429.45Mpa (NBR 2 mm) 2、The femur: 65.523Mpa(PBR 2 mm)、66.767Mpa (AR) and 79.516Mpa (NBR 3 mm) | |||
Pauwels type III(70°) | 3 Models (AR、PBR(2 mm)、NBR(2 mm)) | 1、The implants: 1.2036 mm(PBR 2 mm)、1.2089 mm (AR) and 1.245 mm (NBR 2 mm) 2、The femur: 1.3919 mm(PBR 2 mm)、1.3777 mm (AR) and 1.4068 mm (NBR 2 mm) | 1、The implants: 330.19Mpa(PBR 2 mm)、331.15Mpa (AR) and 383.18Mpa (NBR 2 mm) 2、The femur: 112.19Mpa(PBR 2 mm)、105.94Mpa (AR) and 142.43Mpa (NBR 4 mm) |
Metrics used to assess the clinical outcomes post-surgery
Hip function score post-surgery
First Author | Year | Journal | LoE | Study design | MINORS Criteriab | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | Total | |||||
Ding et al. | 2016 | Chin J Orthop Trauma | 3 | RCS | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 1 | 17 |
Lu et al. | 2017 | China J. Mod. Med. | 3 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 1 | 17 | |
Tian et al. | 2018 | China J. Mod. Med. | 3 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 1 | 17 | |
Xiong WF et al. | 2019 | J ORTHOP SURG RES | 3 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 1 | 17 | |
Huang K et al. | 2020 | J ORTHOP SURG RES | 3 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 1 | 17 | |
Zhao et al. | 2021 | J ORTHOP SURG RES | 3 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 1 | 17 | |
Zhao GL et al. | 2021 | BioMed Res. Int. | 3 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 18 | |
Yang et al. | 2023 | Chin. J. Repar. Reconstr. Surg. | 3 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 18 | |
Zhu J et al. | 2022 | BioMed Res. Int. | 3 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 18 | |
LI et al. | 2022 | JMMC | 3 | PCS | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 1 | 2 | 2 | 2 | 1 | 21 |
Jiang QL et al. | 2023 | BMC Musculoskelet Disord | 3 | RCS | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 18 |