GENERAL ORTHOPAEDICS
Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(1):8 ANZ J Surg. 2013 Sep;83(9):679-83Sixty patients, over the age of 50, with acute, minimally displaced subcapital neck of femur fractures were randomly assigned into one of two groups to receive treatment with two-hole dynamic hip screws or cannulated screws. Results indicated that while both methods are effective in treating femoral neck fractures, neither one was superior. Functionality at 1 year favoured patients in the cannulated screw group, but became similar to patients who received treatment with two-hole dynamic hip screws at final follow up (24 months).
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Randomization
3/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Neck of femur fractures (NOFFs) are a major contributor to morbidity and mortality worldwide. While incidence rates are decreasing due to improved osteoporosis treatment, a substantial number of individuals still experience this issue. Minimally displaced NOFFs are often managed using internal fixation, but there is debate over which technique provides superior outcomes. The majority of orthopaedic surgeons treat these fractures using two-hole dynamic hip screws (DHS) or three partially threaded cancellous screws, but no study has been completed regarding which is the optimal treatment. The purpose of this study was to compare the outcomes of DHS to cannulated screws, and to identify, if possible, which treatment method offers the best results.
主な研究課題は何ですか？
How does the treatment of minimally displaced neck of femur fractures with two-hole dynamic hip screws compare to treatment with cannulated screws, 2 years after surgery?
重要な知見は？
- Each group had 6 mortalities over the study period (p=0.272). One out of 31 DHS inserted, failed due to the cutting out of the femoral head. This was the only DHS case requiring re-operation with THA. Three out of 29 cannulated screw patients required a reoperation (1 due to screw prominence and 2 due to non-union). No significant difference was found between groups regarding perioperative complications (p>0.05 for all cases of pneumonia, stroke, pressure, and pulmonary embolism).
- A significant loss to follow up at 12 and 24 months was noted in both groups (p<0.05).
- Trends towards a significantly higher average Harris Hip Score were found in favour of the cannulated screw group at 12 months (72 in the DHS group vs. 88 in the cannulated screw group) (p=0.0578), but these findings became much more similar at the final 24 month follow up (75 in the DHS group vs. 82.5 in the cannulated screw group) (p=0.5112).
- A significantly improved average WOMAC score was found in favour of the cannulated screw group, at 12 months (54.5 in the DHS group vs. 20 in the cannulated group)(p=0.0061), but this difference was not found at final follow up (41 in the DHS group vs. 29 in the cannulated group) (p=0.2466).
- No difference was found between the groups when analyzing quality of life assessments (measured by SF-12 and questionnaire) (p>0.05, at all follow up times).
- There was no significant difference between groups, at any time point, regarding radiological outcomes (p>0.05, at all follow up times).
最も覚えておくべきことは？
Re-operations were required in 1/31 patients in the DHS and 3/29 patients in the cannulated screw group. No significant difference was found in terms of quality of life or radiological outcomes in either group. A trend was found regarding functionality that favoured the cancellous screw group, especially at 1 year follow up. It should be noted that the study observed a high level of physical decline in the previously fit, independently ambulating patients regardless of treatment.
それが私の患者ケアにどのように影響するか？
The results of this study cannot definitively state that two-hole dynamic hip screws are better than cannulated screws in treating neck of femur fractures (NOFFs) or vice-versa. However, it should be noted that both methods are effective in treating NOFFs. Further research must be completed on a larger scale (multi-center, larger sample size) to verify these results and identify possible methods to improve outcomes.
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