Da-Wei Zhang, Hai-Ting Hong, Liang-He Lin, Zhen-Xin Fu
This field has undergone four paradigm shifts from biomechanical description to perioperative comprehensive management. Although China ranks among the top-tier publishing nations alongside the USA, its research paradigm must transition from technique-oriented toward patient-outcome-oriented and multicenter evidence-based approaches to bridge the persistent citation impact gap.
BACKGROUND: The core clinical decision in geriatric femoral neck fracture-internal fixation vs. arthroplasty-has remained contested for half a century. Although landmark trials such as FAITH, HEALTH, and WHiTE 5 have profoundly reshaped clinical practice, no bibliometric study has systematically mapped the complete research architecture and knowledge evolution trajectory of this field from 1975 to the present. This study aimed to characterize the global research landscape and knowledge evolution of surgical treatment for geriatric femoral neck fracture using a tri-tool framework integrating CiteSpace, VOSviewer, and Bibliometrix with dual-database validation (WoSCC + Scopus).
METHODS: The WoSCC and Scopus databases were searched in parallel on May 24, 2026, with no date restriction. WoSCC yielded 2,147 documents (1,906 articles and 241 reviews); Scopus yielded 6,019 documents (5,689 articles and 330 reviews). After DOI-based deduplication, approximately 6,592 unique records remained. WoSCC served as the primary analytical dataset, with Scopus providing independent multi-database validation. Bibliometrix was used for descriptive statistics, VOSviewer for keyword co-occurrence and country collaboration networks, and CiteSpace for keyword/reference burst detection, co-citation clustering, and timeline analysis.
RESULTS: (1) Annual publications grew from 1 in 1975 to 203 in 2025. (2) The USA and China constitute the first-tier publishing nations (1,029 vs. 1,020 publications), yet China's average citations per article (11.5) lag substantially behind those of the United Kingdom and Sweden. (3) Bhandari M (43 publications) and Frihagen F (33 publications) were the most prolific authors; Injury was the top journal (144 publications). (4) Keyword burst analysis revealed a four-era knowledge evolution with distinct burst signatures: Foundational Era (1991-2001, femur 26.22), Fixation Debate Era (2002-2013, internal-fixation 15.28), Landmark Trial Era (2014-2018), and Perioperative Medicine Era (2019-present, femoral neck system 10.74). (5) The strongest citation bursts were the HEALTH trial (NEJM, strength 33.85) and Keating 2006 (JBJS Am, 29.19).
CONCLUSIONS: This field has undergone four paradigm shifts from biomechanical description to perioperative comprehensive management. Although China ranks among the top-tier publishing nations alongside the USA, its research paradigm must transition from technique-oriented toward patient-outcome-oriented and multicenter evidence-based approaches to bridge the persistent citation impact gap.