Comparing the Clinical and Radiological Outcome of Femoral Neck System Versus Dynamic Hip Screw in Femoral Neck Fractures

Purpose Since its introduction in 1964, the dynamic hip screw (DHS) has remained a mainstay in treatment, offering reliable fixation, high union rates, and early weight-bearing. However, its invasive nature poses a risk of compromising the femoral head's blood supply. On the other hand, multiple cancellous cannulated screw (CCS) allow for a minimally invasive approach but often limit early mobilization. In 2018, DePuy Synthes, Switzerland, introduced the femoral neck system (FNS), promising stability of the fixation equivalent to DHS while maintaining the minimally invasive nature of the procedure. This study aims to compare the clinical and radiological outcomes of DHS and FNS. Methodology A prospective, comparative study was conducted among 120 patients with femoral neck fractures, divided randomly into two groups to remove confounding: Group A (n = 60) - treated with FNS; Group B (n = 60) - treated with DHS. Intraoperative parameters assessed included duration of surgery, blood loss, number of C-arm shoots, and length of incision. Postoperative outcomes were evaluated using the Harris Hip Score, radiological union, and complications such as AVN, varus malunion, femoral neck shortening, and screw back-out were noted. Results The study revealed statistically significant advantages of FNS over DHS in intraoperative parameters: mean duration of surgery: FNS - 28.9 min vs. DHS - 47.86 min (p < 0.05), mean blood loss: FNS - 12.53 mL vs. DHS - 38.91 mL (p < 0.05), mean C-arm exposures: FNS - 17.68 vs. DHS - 23.55 (p < 0.05), mean incision length: FNS - 4.76 cm vs. DHS - 11.53 cm (p < 0.05). Postoperative outcomes showed a comparable union rate (16.13 FNS vs. 16.03 DHS), but the Harris Hip Score was higher with FNS 63.76, 76.55, and 88.88 vs. DHS 60.96,76.21, and 88.01 at 4, 12, and 24 weeks, respectively. Early results and final outcome are in favor of FNS (p < 0.05). A total of 32 complications were observed: 11 in FNS vs. 21 in DHS. Conclusion FNS significantly outperformed DHS in terms of operative efficiency, reduced blood loss, smaller surgical exposure, and fewer complications. These findings suggest that the FNS is a superior and more suitable alternative for the treatment of femoral neck fractures, especially in younger patients.