Clinical efficacy of manual reverse closed reduction and robot-assisted cannulated screw fixation for valgus-impacted osteoporotic femoral neck fractures in the elderly: a retrospective cohort study.

Achieving anatomical restoration in valgus-impacted femoral neck fractures remains a clinical challenge, particularly in the elderly. This retrospective study evaluated a "dual-optimization" strategy-integrating manual reverse closed reduction with robotic-assisted internal fixation-compared to conventional in-situ freehand fixation. Seventy-two patients were divided into the reduction-assisted (RA, n = 36) and in-situ freehand (IF, n = 36) groups. While the RA group required longer operative times (1.74 ± 0.63 h vs. 1.29 ± 0.37 h, p < 0.05), it demonstrated superior technical precision with significantly fewer fluoroscopy sessions (33.28 ± 7.71 vs. 56.56 ± 19.71) and guide-pin adjustments (0.17 ± 0.38 vs. 1.89 ± 1.09, p < 0.0001). Radiologically, the RA group achieved effective deformity correction (valgus and posterior tilt angles, p < 0.0001) and exhibited higher screw placement accuracy (5.92 ± 3.75° vs. 11.14 ± 5.28°) and superior screw dispersion (22.10 ± 1.47% vs. 18.83 ± 1.22%, p < 0.05). At 24-36 months follow-up, the RA group showed significantly less femoral neck shortening (2.5 ± 2.1 mm vs. 9.1 ± 3.8 mm, p < 0.0001) and higher Harris Hip Scores (82.00 ± 11.44 vs. 73.61 ± 15.07, p < 0.05). Furthermore, the RA group had markedly lower incidences of femoral head necrosis (5.56% vs. 25.00%), non-union (8.33% vs. 27.78%), and fixation failure (5.56% vs. 22.22%, p < 0.05). In conclusion, within the limitations of this cohort, combining manual reverse reduction with robotic assistance synergistically may provide clinical benefits by improving surgical precision and maintaining femoral neck anatomy, showing a positive tendency toward better functional recovery and reduced complications for geriatric valgus-impacted fractures.