Treatment of Femoral Neck Fractures in Adults With Improved Biplane Double-Supported Screw Fixation and Femoral Neck System: Complications and Surgical Techniques

Objectives: Treating femoral neck fractures remains a significant challenge for orthopedic surgeons and imposes a substantial economic burden on developing regions. Current novel internal fixation methods demonstrate excellent biomechanical performance. However, these new internal fixation methods are still associated with various complications. This study aimed to report the clinical complications of femoral neck system (FNS) and biplane double-supported screw fixation (BDSF) treatments for femoral neck fractures at our institution and provide directions for selecting cost-effective internal fixation methods.

Methods: A retrospective case-control study of adult patients with femoral neck fractures treated with BDSF or FNS was conducted at Nanfang Hospital from April 2019 to April 2022. General medical records were collected both preoperatively and intraoperatively. Primary complication measures included osteonecrosis of the femoral head, nonunion, screw-out, and subtrochanteric fractures, along with femoral neck shortening. The primary functional measure evaluated was the Harris hip score. This study employed t-test, Wilcoxon rank-sum test, and chi-square test to statistically analyze the data.

Results: Statistically significant differences were observed between the BDSF and FNS groups in terms of surgery duration (60.8 ± 12.6 min vs. 71.0 ± 12.0 min), incision length (5.5 ± 1.2 cm vs. 9.1 ± 1.6 cm) and hospitalization costs (39563.8 ± 9086.4 RMB vs. 24960.4 ± 10154.4 RMB). No statistically significant differences between the BDSF and FNS groups were found in the baseline data, blood loss or hospital stay. Moderate femoral neck shortening was significantly less common in the BDSF group than in the FNS group (27.1% vs. 61.5%, p = 0.016). Postoperatively, no statistically significant differences in complication rates, such as femoral head necrosis, nonunion, subtrochanteric fractures or screw-out, were observed between the BDSF and FNS groups.

Conclusions: This study revealed no significant difference in the incidence of postoperative complications such as femoral head necrosis, nonunion or screw cut-out between BDSF and FNS. Although BDSF has drawbacks, such as a long learning curve and the potential to cause subtrochanteric fractures, it is cost-effective and better maintains the length of the femoral neck. The modified BDSF technique may be more suitable for developing regions with limited health care budgets.