Clinical and radiographic outcomes of cannulated cancellous screw osteosynthesis with and without side-plate for nondisplaced femoral neck fractures: a multicenter propensity score-matched study.

PURPOSE: This study aimed to evaluate postoperative outcomes, including clinical results, radiological assessments, and complications, in patients over 50 years old with nondisplaced femoral neck fractures (Garden classification I-II) treated with cannulated cancellous screw (CCS) fixation with or without a side-plate.

METHODS

This multicenter retrospective study analyzed 620 patients aged ≥ 50 years with nondisplaced femoral neck fractures who underwent osteosynthesis between 2018 and 2020 across 12 affiliated hospitals. After propensity score matching, 41 patients were included in each group. All patients were followed for at least one year postoperatively. Patients were categorized into a CCS group (Group C) and a CCS with side-plate group (Group P). Walking ability, radiological evaluations, operative time, and complications were assessed.

RESULTS

At six months postoperatively, femoral neck shortening did not differ significantly between Group C and Group P (C: 4.20 ± 5.37 vs P: 3.63 ± 3.29 mm, p = 0.701). At one year postoperatively, femoral neck shortening was significantly greater in Group C than in Group P (C: 5.58 ± 4.38 vs P: 2.99 ± 3.64 mm, p = 0.009). Walking ability at final follow-up did not differ between groups (p = 0.142). Operative time was longer in Group P (C: 33.85 ± 15.56 vs P: 56.37 ± 21.63 min, p < 0.001). Postoperative complications were comparable between groups.

CONCLUSIONS

Plate augmentation reduced femoral neck shortening but increased operative time, without significant differences in complications or walking ability. CCS fixation without a side-plate may be sufficient for selected patients with nondisplaced femoral neck fractures.