Femoral Neck System in Pauwell III Femoral Neck Fractures: A Bibliometric Analysis and Review

The femoral neck system (FNS) is a relatively new internal fixation device designed to improve stability in unstable femoral neck fractures. Despite its increasing use, a comprehensive mapping of the research landscape regarding its application in high-shear Pauwels III fractures is lacking. This study aims to provide a bibliometric analysis of the current literature to identify trends, research hotspots, and evidence gaps. A systematic search of the PubMed database was conducted for studies published between 2017 and 2026. Data extraction included publication year, source journals, authorship, institutional affiliations, and country of origin. Bibliometric mapping was performed using the R-package Bibliometrix. Studies were categorized by methodology (Clinical, Biomechanical/Cadaveric, Finite Element Analysis, or Mixed) and level of evidence. Thirty-five studies were identified, with a mean document age of 2.51 years, reflecting a burgeoning interest in the FNS. Research is heavily concentrated in East Asia, with China contributing 88.5% (n=31) of the total output. BMC Musculoskeletal Disorders was the most prolific journal (n=7). The majority of studies utilized computational or experimental designs: 14 FEA, nine biomechanical/cadaveric, and nine clinical studies. Notably, most clinical studies were retrospective cohorts providing Level III evidence, with an absence of Level I or II randomized controlled trials. The evidence base for the FNS in Pauwels III fractures is rapidly expanding but remains in a foundational phase dominated by biomechanical and finite element simulations. While early clinical results from specialized centers in China are promising, there is a critical need for prospective, multicenter international trials to elevate the level of evidence and validate long-term patient outcomes across diverse populations.