Research progress on internal fixation failure of femoral neck fractures

LIN Hong-yu; WANG Tai-you; ZHU Fu-kang; QIAO Bo

doi:10.3969/j.issn.2095-252X.2025.09.014

Abstract：Femoral Neck Fractures (FNF) represent a prevalent subtype of hip fractures encountered in clinical practice. However, the current failure rate of internal fixation in treating FNF remains relatively high. The pathophysiological mechanisms underlying internal fixation failure are complex and involve multifactorial interactions. Key factors, including patient age, fracture classification, quality of anatomical reduction, bone metabolic status, and timing of surgical intervention, have been demonstrated to exert significant influences on the long-term outcomes of internal fixation for FNF. For the clinical diagnosis of internal fixation failure, a comprehensive assessment utilizing imaging techniques such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) is employed. In terms of therapeutic strategy selection, both revision surgery and arthroplasty constitute viable options, yet they exhibit notable disparities in surgical indications, complication profiles, and long-term functional prognoses. During the clinical decision-making process, individualized factors such as the patient's underlying comorbidities, bone quality status, postoperative functional requirements, and life expectancy must be systematically evaluated to formulate an optimal treatment plan. This article systematically reviews the multidimensional factors influencing internal fixation failure in FNF and provides a standardized overview of the diagnostic approaches and therapeutic strategy selection, aiming to furnish clinicians with evidence-based guidance and standardized diagnostic and therapeutic references for managing such complex cases.