Comparative study of rhBMP-2 assisted femoral neck system and cannulated screws in femoral neck fractures: clinical efficacy and psychological status

This study investigated the clinical efficacy and psychological effects of the femoral neck system (FNS) combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) and cannulate compression screw (CCS) in treating unstable femoral neck fractures in young adults. We conducted a retrospective analysis of clinical data from 61 patients with femoral neck fractures who met our selection criteria and were admitted to our hospital between December 2019 and 2022. Patients were divided into two groups based on their internal fixation. Group A received hollow compression screw fixation, whereas Group B underwent FNS combined with rhBMP-2 fixation. We recorded preoperative and last follow-up scores on the self-rating depression scale (SDS) and self-rating anxiety scale (SAS), along with surgery duration, intraoperative fluoroscopy frequency, blood loss, postoperative recovery, and complication rates for both groups. Routine postoperative radiographs were used to evaluate fracture reduction and internal fixation, while Harris scores were used to assess hip joint function. Both groups were followed up for 7-38 months, averaging 25.25 ± 7.62 months. However, intraoperative blood loss was significantly lower in Group A than in Group B, and Group A experienced significantly more fluoroscopy sessions (P < 0.05). In Group A, complications included six cases of nail retraction, three cases of femoral neck shortening, four cases of femoral head necrosis, and one case of bone nonunion. At the last follow-up, femoral neck shortening differed significantly from that in the healthy side (P < 0.05), as did femoral eccentricity (P < 0.05). In Group B, there were three cases of femoral neck shortening, including one nonunion, and four cases of femoral head necrosis. No significant differences in femoral neck shortening were observed compared to the healthy side (P > 0.05), and no significant change was seen in femoral eccentricity from the first to the last follow-up (P > 0.05). Preoperatively, no significant differences in femoral neck shortening and eccentricity were found between the two groups (P > 0.05). Both groups demonstrated good recovery in hip joint function. However, there were significant differences preoperatively and in the last follow-up SDS and SAS scores (P < 0.05). The combination of FNS and rhBMP-2 for treating femoral neck fractures is minimally invasive and easy to perform and offers greater stability. This approach promotes fracture healing with minimal irritation to surrounding muscles and soft tissues, facilitating early weight-bearing and functional rehabilitation. Both surgical methods effectively enhance the psychological well-being of patients with femoral neck fractures who experience anxiety and depression, thereby improving their quality of life and achieving satisfactory short-term therapeutic outcomes.