Comparison of internal fixation outcomes in young femoral neck fractures: three cannulated compression screws versus the femoral neck system

Background Femoral neck fractures in young patients typically result from traumatic injury, present significant treatment challenges, and are associated with a high risk of complications. The cannulated compression screw (CCS) is a common fixation device, whereas the femoral neck system (FNS) is a newer fixation device. Objective To compare the clinical efficacy of the FNS and CCS in the treatment of femoral neck fractures in young patients. Methods Between September 2021 and September 2023, 82 patients with femoral neck fracture aged 18–60 years were admitted to our hospital. According to the different fixation methods, the patients were divided into the FNS (38 cases) and CCS (44 cases) groups. The perioperative indicators, complications and follow-up function scores were compared between the two groups, and the follow-up time was ≥ 12 months. Results The FNS group had shorter operation time (53.71 ± 11.20 vs. 64.61 ± 11.27 min, p < 0.001) and fewer intraoperative fluoroscopy times (14.05 ± 3.13 vs. 21.55 ± 5.06, p < 0.001). However, the incision length (38.05 ± 8.85 mm vs. 20.32 ± 6.34 mm, p < 0.001) and intraoperative blood loss (85.82 ± 23.62 mL vs. 65.89 ± 20.98 mL, p < 0.001) were greater. The FNS group demonstrated a lower rate of fixation failure (5.26% vs. 22.73%, p = 0.026) and a lower incidence of lateral thigh irritation (7.89% vs. 29.55%, p = 0.014), along with less severe femoral neck shortening (4.68 ± 2.04 vs. 7.14 ± 2.27 mm, p < 0.001). Patients in the FNS group achieved partial weight-bearing (3.08 ± 1.16 vs. 5.30 ± 1.50 weeks, p < 0.001) and full weight-bearing (11.71 ± 1.84 vs. 14.39 ± 2.07 weeks, p < 0.001) significantly earlier. The VAS scores at 3 and 7 days after surgery were significantly lower ( p < 0.001), and the Harris scores at 3, 6, and 12 months after surgery were significantly higher ( p < 0.05); however, the magnitude of Harris score differences fell below the minimal clinically important difference (MCID), and both groups achieved excellent final outcomes. Conclusion Compared to CCS, FNS has better intraoperative efficiency, a lower internal fixation failure rate, and less severe femoral neck shortening in the treatment of femoral neck fractures in young adults. However, given the retrospective design, relatively small sample size, limited follow-up time, and differential follow-up duration between the groups, these conclusions should be interpreted with caution.