Femoral neck system versus multiple cannulated screws for the treatment of intracapsular femoral neck fractures—a propensity score matched cohort study

Abstract

Introduction: We investigate the outcomes of the recently launched angle-stable femoral neck system (FNS) against conventional multiple cannulated screws (MCS) for the treatment of intracapsular fracture neck of femur using a retrospective propensity score matched cohort study design. Methods: Consecutive adult patients receiving either MCS or FNS for intracapsular neck of femur fractures from Jan 2018 to March 2021 in five hospitals (QMH, PMH, AHNH, TKOH, GHK) were reviewed. Propensity score matching was performed using baseline confounders including age, sex, garden classification, Charlson comorbidity score and premorbid walking status, with nearest neighbour matching and a caliber value of 0.2. Results: Of 221 patients, 76 patients with FNS were matched against 76 patients with MCS and reviewed. The mean age was 74.6 and 79.6% were females. After matching the two groups, the confounding factors were controlled within a standardised difference in means of <0.07. At latest follow-up, FNS treated patients had significantly fewer femoral head penetrations (0% vs 7.4%, p=0.028), fewer avascular necrosis (1.6% vs 10.3%, p=0.038). There is no significant difference in the extent of collapse, implant migration, reoperations, functional walking status and mortality. Discussion and Conclusion: Our observations support the use of FNS as a promising alternative to MCS for intracapsular neck of femur fractures.