The impact of removing cannulated screws after femoral neck fracture surgery on middle-aged and young patients

This study aims to evaluate whether the removal of cannulated screws after healing in femoral neck fractures increases the risk of osteonecrosis of the femoral head (ONFH) in middle-aged and young patients, and to explore the potential effects of screw removal on these individuals. A retrospective study was conducted involving 112 patients with simple femoral neck fractures treated between July 2017 and July 2021. All patients underwent closed reduction and internal fixation with inverted triangular cannulated screws by a single senior surgeon within 72 hours of injury. The study categorized 30 patients who had their screws removed 1 year after healing into the "removal group," while the remaining 82 patients who retained their screws formed the "retention group." Outcomes measured included the incidence of ONFH, Harris hip scores, and SF-36 questionnaire scores. Patients with ONFH, fixation failure, or nonunion were excluded from the analysis of the Harris hip score and SF-36 results. Follow-up duration ranged from 24 to 32 months, with an average of 26 months, and there were no cases of fixation failure or nonunion. Age, BMI, and gender were comparable between the 2 groups (P > .05). ONFH was observed in 14 patients (17%) from the retention group and 10 patients (33.3%) from the removal group, with no significant difference (P > .05). At 1-year post-injury, both Harris hip and SF-36 scores showed no significant differences between groups (P > .05). However, at 2 years, the removal group demonstrated significantly higher scores than the retention group (P < .05). Removing cannulated screws from the femoral neck in healthy middle-aged and young patients does not increase the risk of ONFH and may enhance their quality of life.