• Wen-Nan Xu and Qing-Yun Xue.
• Orthopaedics Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
• Orthop Surg. 2021 Feb 1; 13 (1): 3-13.

ObjectiveTo compare the long-term efficacy of screw fixation and hemiarthroplasty in elderly patients with undisplaced femoral neck fractures.MethodsWe searched Cochrane Library, EMBASE, and MEDLINE from inception to 10 June 2020 to identify studies about undisplaced femoral neck fracture in elderly patients over 65 years of age. The included studies were assessed by two researchers according to the Cochrane risk-of-bias criteria and Newcastle-Ottawa Scale. Meta-analysis was performed with Revman 5.3 software. The odds ratios (OR) and mean differences (MD) were used to compare dichotomous and continuous variables.ResultsA total of 750 patients were included in this meta-analysis. In elderly patients, undisplaced femoral neck fracture treated with hemiarthroplasty had a lower implant-related complication rate (OR, 4.05 [95% CI, 2.38 to 6.89]; P < 0.00001; I2 = 0), lower reoperation rate (OR, 4.88 [95% CI, 2.84 to 8.38]; P < 0.00001; I2 = 0), and superior Harris score (WMD, -5.05 [95% CI, -7.30 to -2.80]; P < 0.0001; I2 = 0) in the early postoperative period. Although screw fixation was associated with shorter operative time (WMD, -36.22 [95% CI, -50.72 to -21.73]; P < 0.00001; I2 = 98%) and less blood loss (WMD, -165.84 [95% CI, -209.29 to -122.38]; P < 0.00001; I2 = 96%), there was no significant difference in long-term mortality (OR, 0.65 [95% CI, 0.28 to 1.48]; P < 0.31; I2 = 75%) between these two treatments.ConclusionIn elderly patients with undisplaced femoral neck fractures, hemiarthroplasty provided a lower implant-related complication rate, lower reoperation rate, superior hip function without increased long-term mortality. Hemiarthroplasty should be recommended as a better alternative in such patients compared with multiple cannulated screws.© 2021 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

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