Background: The There are few studies in the orthopaedic surgery literature that examine clinical outcomes for femoral neck system (FNS) fixation of femoral neck fractures. The purpose of this study was to compare primary outcome of non-union for femoral neck fracture fixation using FNS versus multiple cannulated screws (MCS).
Methods: Retrospective electronic medical record search for patients 18 years or older who underwent surgery between March 01, 2018 and September 01, 2021 for femoral neck fracture fixation. Two reviewers examined radiographic and clinical data reaching consensus. Patients were called via telephone to complete Short Form 12-item (SF-12) surveys with consent. Survey completion rate was 22% (21/88). Twenty-one FNS and sixty-seven MCS patients met inclusion criteria. Average age was 77 years for MCS and 63 for FNS (p=0.0065). There were no significant differences in functional status (p=0.2543) or any comorbidities between groups.
Results: Two (2.99%) MCS patients went to nonunion versus four (19.05%) FNS (p=0.027). Average age for FNS non- union patients was 44.5 years. Injuries were 75% (3/4) displaced and 25% (1/4) nondisplaced for FNS. Rate of any compli- cation was 29.85% (20/67) for MCS and 52.3% (11/21) for FNS (p=0.0711). There was a significant difference in surgical time of 47.81 (MCS) and 89.71 minutes (FNS) (p=<0.0001). Sub-analysis of patients 60 years or older included 12 FNS and 61 MCS. Length of stay was significantly different with 6.72 days (MCS) compared to 3.92 days (FNS) (p=0.0336). One (1.64%) MCS patients went to nonunion versus 0 (0%) FNS (p=>0.9999).
Conclusion: There was longer surgical time, possibly higher overall complication rate, and risk for nonunion in younger patients with displaced femoral neck fractures when treated with FNS. Previous reports showing shorter surgical case time using the FNS may point to a learning curve. Surgeons should take this into account when beginning to use this system. Level of evidence: Level III
