A recent update on the fixation techniques for femoral neck fractures: A narrative review

Abstract

Femoral neck fractures present significant challenges in orthopedic surgery, particularly due to technical difficulties and a high complication rate. Surgical intervention is generally recommended, with osteosynthesis and arthroplasty being the main treatment options. Osteosynthesis techniques, including dynamic hip screw (DHS), multiple cannulated screws (MCS), and the femoral neck system (FNS), aim to achieve stable fixation and facilitate fracture healing. Factors influencing the choice of osteosynthesis include fracture displacement, bone quality, patient age, and the presence of posterior tilt. While DHS offers high stability, MCS is preferred in stable type fractures with minimal invasive procedures. FNS, a newer technique, combines the advantages of DHS and MCS, providing strong fixation with minimal soft tissue damage. Considering the comprehensive findings of biomechanical and clinical studies to date, when performing osteosynthesis for unstable femoral neck fractures, caution should be exercised with MCS as it may have slightly inadequate fixation strength compared to DHS and FNS. FNS, being the newest technique, demonstrates superior fixation strength comparable to DHS and is as minimally invasive as MCS. However, it is essential to remember that long-term follow-up results are lacking for FNS.

Keywords: Dynamic hip screw; Femoral neck fracture; Femoral neck system; Multiple cannulated screw; Osteosynthesis.

Fig. 1

51 years male who underwent DHS surgery due to unstable femoral neck fracture. The preoperative (A) anterior-posterior and (B) lateral view X-rays were shown displaced type femoral neck fracture, and the (C) anterior-posterior and (D) lateral view X-rays of postoperative 2-year without any complications.

Fig. 2

79 years male who underwent MCS due to femoral neck fracture. (A) The initial preoperative (A) anterior-posterior and (B) lateral view X-ray, immediate postoperative status (C) anterior-posterior and (D) lateral view X-ray, and postoperative 5-years final follow-up (E) anterior-posterior and (F) lateral view X-ray.

Fig. 3

60 years old female who underwent FNS surgery due to the stable femoral neck fracture. The preoperative anterior-posterior and lateral view X-rays were shown in (A) and (B), and the (C) anterior-posterior and (D) lateral view X-rays of postoperative 1-year without any complications.