Femoral neck system versus dual-plane vertical fixation with cannulated screws for femoral neck fractures in young and middle-aged adults:clinical outcome comparison

Li Chong; Li Lei; Li Meng; Zhou Yonghui; Xu Wei; Xu Lei; Fang Shiyuan

doi:10.3969/j.issn.1009-4237.2025.03.005

Abstract：Objective To evaluate and compare the clinical efficacy between femoral neck system(FNS)and four cannulated screws(4CS)dual-plane vertical fixation in treating Pauwels type Ⅲ femoral neck fractures in young and middle-aged patients.Methods A retrospective analysis was conducted on 65 patients with primary Pauwels type Ⅲ femoral neck fractures treated at our department from Jun.2021 to Dec.2022.The cohort included 34 males and 31 females,with an age range of 18 to 63 years(mean 44.3 years).The causes of injury were road traffic accidents in 32 cases and falls from height in 33.Based on the surgical fixation,patients were divided into two groups:the FNS group(35 cases)and the 4CS group(30 cases).No statistically significant difference was found between the two groups in terms of age,gender,injury location,time from injury to surgery,underlying diseases,or mechanism of injury(P>0.05).Key variables analyzed for both groups included demographic and clinical charac-teristics,perioperative indicators,postoperative outcomes and complications,as well as hip joint function assessed by the Harris hip score(HHS),and pain evaluated by VAS at 1 day,6 and 12 months after surgery and final follow-up.Results All patients were followed up for 12 to 36 months,with all achieving bone healing.In terms of periopera-tive indicators,the 4CS group had a significantly shorter incision length(cm,3.6±0.5 vs.6.8±1.0)and fewer flu-oroscopy times(61.1±5.0 vs.70.0±5.6)than the FNS group(both P<0.001).Regarding postoperative outcomes and complications,although the 4CS group had a slower start of weight-bearing compared to the FNS group,it demon-strated significant advantages in full weight-bearing time(weeks,11.7±2.0 vs.15.6±2.8),fracture healing time(weeks,15.1±1.9 vs.18.1±2.8),and femoral neck shortening(mm,2.5±0.7 vs.4.3±1.1),all P<0.001.No avascular necrosis was observed in either group until the last follow-up.Throughout the entire follow-up period,the HHS for hip joint function in the 4CS group was significantly higher than that in the FNS group(all P<0.05),and the VAS was significantly lower(all P<0.05).Conclusion Compared with the FNS,the 4CS demonstrates signifi-cantly better clinical efficacy in the treatment of femoral neck fractures in young and middle-aged adults,with advan-tages such as less fluoroscopy,shorter incision length,reduced femoral neck shortening,and quicker fracture healing.