Clémence Baetz, Adrien Maupetit, Clément Marc, Louis Rony, Guillaume David
Within a 24-hour treatment pathway, further reduction of time to surgery was not associated with improved survival in this cohort. Mortality was strongly associated with perioperative medical complications. These findings support current early-surgery targets but suggest that optimisation of perioperative and orthogeriatric care may be at least as important for improving outcomes as further reductions in time to surgery.
BACKGROUND: The Femoral Neck System (FNS) has been introduced as a minimally invasive alternative to the Dynamic Hip Screw (DHS) for intracapsular femoral neck fracture fixation. Comparative data on early mechanical failure patterns remain limited.
PURPOSE: To describe the early mechanical complications observed after FNS and DHS fixation during a period of progressive FNS adoption, without assuming implant-specific causality.
METHODS: This retrospective single-center cohort included 130 consecutive patients treated between December 2020 and January 2024 (42 DHS, 88 FNS). The primary outcome was mechanical revision within one year. Tip-apex distance (TAD) and postoperative reduction quality using the Garden Alignment Index (GAI) were assessed on immediate postoperative radiographs.
RESULTS: Mechanical revision occurred in 3 DHS patients (7.1%; 95% CI 1.5-19.5%) and 8 FNS patients (9.1%; 95% CI 4.0-17.1%; p = 0.25). Reduction was acceptable in 40/42 DHS and 80/88 FNS patients (p = 0.50). Mechanical failure occurred in 5/10 patients with unacceptable reduction versus 6/120 with acceptable reduction (p < 0.001). Mean TAD was similar between groups (18.8 ± 4.8 versus 19.6 ± 5.2 mm; p = 0.34), and all four cut-outs occurred with TAD >25 mm. Observed failure patterns included shortening/medialization and cut-out after DHS, and shortening/medialization, cut-out, and peri-implant fracture after FNS.
CONCLUSION: Different mechanical complications were observed after DHS and FNS fixation, but confounding by indication and the small number of events preclude implant-specific causal conclusions. Reduction quality and implant positioning appear important determinants of early mechanical failure.