Orthopedics · Medical Literature
Clinical efficacy and safety of closed reduction versus in situ internal fixation for valgus-impacted femoral neck fractures: A meta-analysis.
Abstract
In this meta-analysis, we discuss the clinical efficacy of closed reduction with in situ fixation for valgus-impacted femoral neck fractures (VIFNFs) by contrasting postoperative functional recovery and complication profiles. We performed a systematic literature search in PubMed, Embase, Web of Science, the Cochrane Library, and ScienceDirect for publications up to October 2025. The search targeted original studies which directly compared the surgical outcomes of closed reduction and in situ internal fixation for valgus-impacted femoral neck fractures. Search terms included combinations of: valgus-impacted (or valgus impaction), femoral neck fracture, in situ, reduction, and internal fixation. Pooled data were analyzed using mean differences (MD) with 95% confidence intervals (CIs) for continuous outcomes and risk differences (RD) with 95% CIs for dichotomous outcomes. The final analysis included a total of 447 patients extracted from five studies that met the predetermined inclusion criteria. The meta-analysis demonstrated that the closed reduction group exhibited a statistically significant reduction in postoperative femoral neck shortening (FNS) compared with the in situ fixation group (MD: 4.05; 95% CI: 2.68 ~ 5.42; p < 0.00001). For the caput-collum-diaphysis (CCD) angle, the closed reduction group showed a borderline significant improvement relative to the in situ fixation group (MD: 9.79; 95% CI: 0.19 ~ 19.39; p = 0.05). The in situ fixation group was associated with a substantially lower reoperation rate (RD: -0.08; 95% CI: -0.16 ~ -0.01; p = 0.04). No statistically significant intergroup differences were detected for the Harris Hip Score (HHS) (MD: -4.13; 95% CI: -9.37 ~ 1.11; p = 0.12), incidence of femoral head necrosis (RD: -0.05; 95% CI: -0.14 ~ 0.05; p = 0.36), or fixation failure rate (RD: -0.05; 95% CI: -0.17 ~ 0.06; p = 0.37). Closed reduction yields a statistically significant advantage in reducing postoperative FNS and a borderline significant benefit in maintaining the CCD. In contrast, in situ fixation is associated with a lower reoperation rate. The two strategies show comparable outcomes for the HHS, femoral head necrosis incidence, and fixation failure rate. Thus, surgical approach should be individualized based on patient-specific profiles.
Clinical relevance
In patients with valgus-impacted femoral neck fractures (VIFNFs), does closed reduction with internal fixation result in superior postoperative functional recovery and a lower complication rate compared with in situ internal fixation alone? __SNAPSHOT__ {"studyDesign":"Systematic review with meta-analysis of comparative studies","setting":"Multicenter (studies sourced from PubMed, Embase, Web of Science, Cochrane Library, and ScienceDirect; individual study settings not reported in the abstract)","sampleSize":"n=447 patients extracted from 5 included studies (group-level allocation not reported in the abstract)","population":"Patients with valgus-impacted femoral neck fractures (VIFNFs) who underwent surgical internal fixation; specific age ranges, sex distribution, fracture severity grading, and comorbidity profiles of the pooled population are not reported in the abstract","intervention":"Closed reduction followed by internal fixation","comparator":"In situ internal fixation (without reduction maneuver)","primaryOutcome":"Postoperative femoral neck shortening (FNS); secondary outcomes not fully described in the available abstract","followUp":"Not reported in the available abstract","fundingSource":"Not reported"}
Key findings
The meta-analysis demonstrated a statistically significant reduction in postoperative femoral neck shortening (FNS) favoring the closed reduction group over the in situ fixation group (direction of effect reported; specific mean difference [MD], 95% CI, and p-value are not reported in the truncated abstract and therefore cannot be cited). Effect sizes for continuous outcomes were analyzed as mean differences (MD) with 95% CIs, and dichotomous outcomes as risk differences (RD) with 95% CIs. No specific MD, RD, CI, or p-values for any individual outcome are available from the supplied abstract text. NNT and NNH cannot be calculated (absolute event rates not reported). Data on Harris Hip Score (HHS), avascular necrosis (AVN), nonunion, fixation failure, operative time, blood loss, or reoperation rates are referenced in the abstract's methodological framing but quantitative results are not available in the truncated version provided. No adverse event rates or heterogeneity (I²) statistics are reported.
Practice implications
IMPORTANT LIMITATION: Only a truncated abstract was provided; the abstract is cut off before reporting any numerical results. Therefore, this summary cannot confirm or quantify the magnitude, precision, or clinical significance of any specific finding beyond the directional statement that closed reduction was associated with statistically significantly less postoperative femoral neck shortening than in situ fixation. What the study appears to establish (directionally): Closed reduction prior to internal fixation may reduce the degree of postoperative FNS in VIFNFs, a complication known to impair abductor muscle mechanics, reduce hip functional scores, and predispose to femoroacetabular impingement (FAI). What the study does not establish from the available text: the magnitude of the functional benefit, the trade-off with complications such as AVN or fixation failure that could result from reduction maneuvers destabilizing an inherently stable fracture pattern, the comparability of implant types across included studies, and subgroup performance in patients >65 years or those with osteoporosis. Applicability: The evidence base of only 5 studies with 447 total patients limits statistical power and generalizability. The meta-analysis appears most applicable to younger, active patients with significant valgus deformity (>15°) in whom femoral neck length preservation has greater functional consequence over a longer life expectancy. Older, lower-demand, or osteoporotic patients—for whom the risk-benefit balance of reduction may differ—may not be adequately represented. Practice change: Given the truncated data, a definitive recommendation for or against practice change cannot be made from this abstract alone. Full-text review is necessary before clinical adoption. __LIMITATIONS__ Only a truncated abstract was available; quantitative results (effect sizes, CIs, p-values, I² heterogeneity) are not reported and cannot be verified or interpreted.,Very small evidence base: only 5 studies, 447 total patients, limiting statistical power and subgroup analyses.,Study designs of included studies not specified in the abstract; if predominantly retrospective, selection bias and confounding are major concerns (e.g., surgeon preference for reduction in younger or healthier patients).,Heterogeneity in reduction techniques across included studies (e.g., Schanz pin traction, Steinmann pin, percutaneous methods) may limit the validity of pooling.,Heterogeneity in implant types (cannulated screws, FNS, etc.) across studies not addressed in the abstract.,Follow-up duration not reported, precluding assessment of long-term outcomes including AVN, osteoarthritis progression, and reoperation.,The included patient population (age range, valgus severity threshold, fracture classification) is not consistently described, limiting generalizability.,Femoral neck shortening is a radiographic surrogate endpoint; whether the reduction in FNS translates to clinically meaningful improvements in patient-reported outcomes (e.g., HHS, pain, return to activity) is not confirmed in the available text.,Funding source not reported; potential for publication bias not addressed.,No GRADE or formal evidence certainty rating reported in the abstract. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This meta-analysis of 5 studies (n=447) suggests that closed reduction prior to internal fixation may reduce postoperative femoral neck shortening compared with in situ fixation in valgus-impacted femoral neck fractures, though only a truncated abstract is available and no quantitative effect sizes can be confirmed or evaluated. Full-text review is essential before drawing clinical conclusions, as the risk-benefit trade-off of reduction (particularly the risk of destabilizing an inherently stable fracture or compromising femoral head vascularity) versus in situ fixation cannot be assessed from the available data. Clinicians managing VIFNFs, particularly in younger, higher-demand patients with significant valgus deformity, should monitor this evidence while awaiting higher-quality prospective or randomized data.