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Related Concept Videos

Fractures: Bone Repair01:27

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Evidence based update: open versus closed reduction.

Pouriya Ghayoumi1, Utku Kandemir2, Saam Morshed2

  • 1University of California, San Francisco School of Medicine, United States.

Injury
|January 3, 2015
PubMed
Summary
This summary is machine-generated.

Open reduction with internal fixation (ORIF) and closed reduction with internal fixation (CRIF) show similar outcomes for young adults with femoral neck fractures regarding union and avascular necrosis. However, CRIF may have lower surgical site infection rates.

Keywords:
Avascular necrosisClosed reductionComplicationsDeep wound infectionDisplacedFemoral neck fracturesInternal fixationNonunionOpen reductionYoung adults

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Biomedical Engineering

Background:

  • Displaced femoral neck fractures in young adults have high complication rates, including nonunion and avascular necrosis.
  • The optimal surgical approach, specifically the role of open versus closed reduction, remains debated.
  • Reduction quality is a key predictor of successful treatment outcomes.

Purpose of the Study:

  • To systematically review and compare outcomes of open reduction with internal fixation (ORIF) versus closed reduction with internal fixation (CRIF) for acute displaced femoral neck fractures in young adults.
  • To evaluate complication rates, specifically nonunion, avascular necrosis, and deep infection, between ORIF and CRIF.
  • To assess the evidence supporting each reduction technique for improving treatment success.

Main Methods:

  • Systematic review of observational studies, randomized studies, and case series with clear outcome data.
  • Inclusion criteria: acute (surgery < 6 weeks from injury) displaced femoral neck fractures in adults ≤ 50 years, followed for ≥ 1 year.
  • Meta-analysis of risk ratios from six comparative studies to determine differences in complication incidence.

Main Results:

  • No significant difference in nonunion (ORIF 14.9% vs. CRIF 11.6%, P=0.25) or avascular necrosis (ORIF 17.7% vs. CRIF 17.2%, P=0.91) between ORIF and CRIF.
  • Significantly lower incidence of deep wound infection with CRIF (0.49%) compared to ORIF (3.9%, P=0.0019).
  • Meta-analysis confirmed no significant difference in nonunion, avascular necrosis, or total complications between the two techniques.

Conclusions:

  • Current evidence does not support ORIF over CRIF for improving union or preventing avascular necrosis in young adults with displaced femoral neck fractures.
  • CRIF may be associated with a lower risk of surgical site infections compared to ORIF.
  • High-quality prospective studies and patient-reported outcome measures are needed to draw firm conclusions and guide future treatment decisions.