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Objective <p>Based on the pattern of displacement in femoral neck fractures, a comparative study was conducted between a novel fixation strategy using two fully threaded headless cannulated screw combined with one partial threaded cannulated screw, and the traditional approach utilizing three partial threaded cannulated screw.</p> Methods <p>We retrospectively analyzed 120 patients (aged 20–65) with femoral neck fractures treated surgically at the Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, from January 2018 to December 2023. According to the fixation technique used, patients were divided into two groups: the FTHCS group (55 cases), which received a combination of two fully threaded headless cannulated screw (FTHCS) combined with one partial threaded cannulated screw (PTCS), and the PTCS group (65 cases), which received partial threaded cannulated screw. Data collected included baseline characteristics (age, sex, fracture mechanism, and classification), perioperative outcomes (operation time, blood loss, hospital stay), fracture healing time, femoral neck shortening, screw migration, complications (nonunion, implant failure, avascular necrosis of the femoral head), and the final follow-up Harris Hip Score (HHS). These measures were compared to evaluate clinical outcomes between the two fixation strategies.</p> Results <p>During a follow-up of 13–60&#xa0;months (mean 20.4 ± 4.5&#xa0;months), no significant differences were found in baseline characteristics or perioperative parameters between the two groups (<i>P</i> &gt; 0.05), indicating comparable cohorts. Postoperative outcomes also showed no significant differences in fracture healing time, nonunion, avascular necrosis of the femoral head, or femoral head screw cut-out (<i>P</i> &gt; 0.05). However, the FTHCS group achieved a significantly higher HHS (<i>P</i> &lt; 0.05) and significantly lower rates of femoral neck shortening (both &gt; 10&#xa0;mm and &lt; 10&#xa0;mm), implant failure, and lateral screw migration (<i>P</i> &lt; 0.05) compared to the PTCS group.</p> Conclusion <p>For the treatment of femoral neck fractures, both the use of three partial threaded cannulated screw alone and the hybrid fixation with two fully threaded headless cannulated screw combined with one partial threaded cannulated screw can yield satisfactory clinical outcomes. However, compared to the former, although the latter demonstrates certain advantages in reducing femoral neck shortening, improving HHS, and cost-effectiveness, these findings should be interpreted with caution due to the retrospective design of the studies and potential biases. Based on current evidence, hybrid screw configurations appear to be a promising alternative; nevertheless, higher-quality prospective studies are warranted to validate their clinical superiority and support broader application.</p>

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Comparative study on femoral neck fractures treatment: partial threaded cannulated screw versus different combinations of partial threaded cannulated screw and fully threaded headless cannulated screw

  • 期刊论文

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  • 发表日期：

    2025年12月9日

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  • Hongchuan Zhao,
  • Ruiqing Li,
  • Deqiang Meng,
  • Xingfeng Gao,
  • Qiushun Zhang,
  • Qinghua Chang,
  • Yifeng Zhao

摘要

Objective

Based on the pattern of displacement in femoral neck fractures, a comparative study was conducted between a novel fixation strategy using two fully threaded headless cannulated screw combined with one partial threaded cannulated screw, and the traditional approach utilizing three partial threaded cannulated screw.

Methods

We retrospectively analyzed 120 patients (aged 20–65) with femoral neck fractures treated surgically at the Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, from January 2018 to December 2023. According to the fixation technique used, patients were divided into two groups: the FTHCS group (55 cases), which received a combination of two fully threaded headless cannulated screw (FTHCS) combined with one partial threaded cannulated screw (PTCS), and the PTCS group (65 cases), which received partial threaded cannulated screw. Data collected included baseline characteristics (age, sex, fracture mechanism, and classification), perioperative outcomes (operation time, blood loss, hospital stay), fracture healing time, femoral neck shortening, screw migration, complications (nonunion, implant failure, avascular necrosis of the femoral head), and the final follow-up Harris Hip Score (HHS). These measures were compared to evaluate clinical outcomes between the two fixation strategies.

Results

During a follow-up of 13–60 months (mean 20.4 ± 4.5 months), no significant differences were found in baseline characteristics or perioperative parameters between the two groups (P > 0.05), indicating comparable cohorts. Postoperative outcomes also showed no significant differences in fracture healing time, nonunion, avascular necrosis of the femoral head, or femoral head screw cut-out (P > 0.05). However, the FTHCS group achieved a significantly higher HHS (P < 0.05) and significantly lower rates of femoral neck shortening (both > 10 mm and < 10 mm), implant failure, and lateral screw migration (P < 0.05) compared to the PTCS group.

Conclusion

For the treatment of femoral neck fractures, both the use of three partial threaded cannulated screw alone and the hybrid fixation with two fully threaded headless cannulated screw combined with one partial threaded cannulated screw can yield satisfactory clinical outcomes. However, compared to the former, although the latter demonstrates certain advantages in reducing femoral neck shortening, improving HHS, and cost-effectiveness, these findings should be interpreted with caution due to the retrospective design of the studies and potential biases. Based on current evidence, hybrid screw configurations appear to be a promising alternative; nevertheless, higher-quality prospective studies are warranted to validate their clinical superiority and support broader application.