Complications after internal screw fixation of nondisplaced femoral neck fractures in elderly patients: A systematic review

Acta Orthop Traumatol Turc. 2020 May;54(3):337-343. doi: 10.5152/j.aott.2020.03.113.


Objective: Internal fixation with cannulated screws for nondisplaced femoral neck fractures in the elderly has substantial reoperation and mortality rates. The selection of either internal fixation or arthroplasty for nondisplaced femoral neck fracture is debatable.

Methods: We performed a systematic review of the literature regarding complications in the internal fixation of nondisplaced femoral neck fractures in elderly (>60 years old) patients. We searched in multiple databases (PubMed, Web of Science, Embase, and Cochrane Library) for articles in this area; there was no limitation over the publication year.

Results: A total of 1971 patients were identified from 16 published studies. All these patients were over 60 years old. The minimum follow-up after the surgical procedure was 11 months (range: 11-183 months). A total of 329 fractures (16.7%) with radiographic and clinical failures after fixation were identified with regard to stable femoral neck fractures. The single most common complication after surgery was nonunion (129/329), with a pooled percentage of 39.2%. Osteonecrosis was found to be the second most common cause of revision surgery (31.9%). The overall reoperation rate attributable to surgical complications was 15.2% (300/1971 patients). Conversion to hip arthroplasty was performed in 244 patients (12.4%) after primary fixation.

Conclusion: Our study elucidated further the complication rate of nondisplaced femoral neck fractures treated with internal screw fixation. Since the failure rate of screw fixation for stable femoral neck fractures in elderly patients is not low, we believe that hemiarthroplasty is a reasonable treatment option in select patients.

Level of evidence: Level III, Therapeutic study.

Publication types

  • Systematic Review

MeSH terms

  • Aged
  • Bone Screws
  • Comparative Effectiveness Research
  • Femoral Neck Fractures / surgery*
  • Fracture Fixation, Internal* / adverse effects
  • Fracture Fixation, Internal* / instrumentation
  • Fracture Fixation, Internal* / methods
  • Hemiarthroplasty* / adverse effects
  • Hemiarthroplasty* / methods
  • Humans
  • Patient Selection
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / prevention & control