Outcomes of Reduction and Fixation versus In-situ Fixation for Valgus-impacted Femoral Neck Fractures: A Systematic Review

Abstract

Due to the presumed inherent stability of valgus-impacted femoral neck fractures (VIFNF), in-situ fixation has traditionally been the preferred surgical treatment. However, regarding the particular need for reduction before fixation, the optimal surgical strategy for this type of injury remains controversial. A comprehensive literature search was performed using PubMed, Embase, and Cochrane Library databases. Studies comparing outcomes between in-situ fixation and reduction with fixation for VIFNF published between 2014 and 2024 were included. Utilizing the Modified Coleman Methodology Score, study quality was assessed by two independent reviewers. Eleven studies published during the selected timeframe met the inclu-sion criteria. Studies on in-situ fixation reported significant femoral neck (FN) shortening regardless of screw configuration. Two of three comparative studies between in-situ and reduction demonstrated significantly less FN shortening in the in-situ group at the postoperative one year follow-up. Furthermore, all three comparative studies reported significantly higher postoperative 1-year Harris hip scores in the reduction group. For VIFNF, anatomical reduction prior to fixation may improve functional outcomes and reduce FN shortening compared to in-situ fixation. However, reduction techniques may offer better long-term stability and lower complication rates although they require additional surgical steps. Nevertheless, patient selection remains crucial, particularly in elderly or osteoporotic patients where in-situ fixation may still be a viable option. Further prospective randomized controlled trials are needed to confirm these findings.