Frontiers in surgery · 2026
Early clinical and radiographic outcomes of robot-assisted femoral neck system fixation combined with an additional cannulated compression screw for garden IV femoral neck fractures in young and middle-aged adults: a propensity score-matched retrospective cohort study.
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Fengqin Wu, Tueraili Aihelamu, Zhao Yaqiong
Аннотация
BACKGROUND: Garden IV femoral neck fractures in young and middle-aged adults are highly unstable and prone to shortening, nonunion, and femoral head necrosis. We compared robot-assisted femoral neck system (FNS) fixation plus an additional cannulated compression screw (CCS) in a multiplanar configuration with robot-assisted FNS fixation alone.
METHODS: This retrospective cohort included 172 patients aged 18-60 years who were treated from June 2024 to June 2025; 82 underwent robot-assisted FNS plus CCS fixation and 90 underwent robot-assisted FNS fixation alone. After 1:1 nearest-neighbor propensity score matching without replacement (caliper, 0.2 standard deviations of the logit propensity score), 67 matched pairs were analyzed. Femoral neck shortening at 12 months was defined as the primary analytic endpoint for this report; perioperative, rehabilitation, other radiographic, functional, and complication outcomes were secondary or exploratory.
RESULTS: FNS plus CCS required longer operative time (81.67 ± 7.62 vs. 68.67 ± 7.51 min), more fluoroscopic exposures and guidewire adjustments, and a longer total incision (all P < 0.05). It was associated with earlier full weight-bearing (10.74 ± 1.42 vs. 12.47 ± 1.34 weeks), shorter fracture-healing time (4.69 ± 0.52 vs. 5.25 ± 0.43 months), less femoral neck shortening at 12 months (4.46 ± 1.35 vs. 6.08 ± 1.31 mm), and a lower rate of moderate shortening (34.3% vs. 73.1%; all P < 0.001). HHS was higher at 6 and 12 months and VAS was lower at 12 months in the combined group. Any complication occurred in 1.5% versus 10.4% (exact P = 0.070; conditional matched OR, 0.14; exact 95% CI, 0.003-1.11), indicating substantial uncertainty in the safety comparison.
CONCLUSIONS: In this propensity score-matched retrospective cohort, robot-assisted FNS plus an additional CCS was associated with less femoral neck shortening, earlier full weight-bearing, shorter fracture-healing time, and better later functional recovery, at the cost of greater operative complexity. Because the safety analysis was underpowered and follow-up was limited to 12 months, these findings should be interpreted cautiously and do not establish long-term safety or femoral head necrosis risk; prospective multicenter studies with longer follow-up are required.
METHODS: This retrospective cohort included 172 patients aged 18-60 years who were treated from June 2024 to June 2025; 82 underwent robot-assisted FNS plus CCS fixation and 90 underwent robot-assisted FNS fixation alone. After 1:1 nearest-neighbor propensity score matching without replacement (caliper, 0.2 standard deviations of the logit propensity score), 67 matched pairs were analyzed. Femoral neck shortening at 12 months was defined as the primary analytic endpoint for this report; perioperative, rehabilitation, other radiographic, functional, and complication outcomes were secondary or exploratory.
RESULTS: FNS plus CCS required longer operative time (81.67 ± 7.62 vs. 68.67 ± 7.51 min), more fluoroscopic exposures and guidewire adjustments, and a longer total incision (all P < 0.05). It was associated with earlier full weight-bearing (10.74 ± 1.42 vs. 12.47 ± 1.34 weeks), shorter fracture-healing time (4.69 ± 0.52 vs. 5.25 ± 0.43 months), less femoral neck shortening at 12 months (4.46 ± 1.35 vs. 6.08 ± 1.31 mm), and a lower rate of moderate shortening (34.3% vs. 73.1%; all P < 0.001). HHS was higher at 6 and 12 months and VAS was lower at 12 months in the combined group. Any complication occurred in 1.5% versus 10.4% (exact P = 0.070; conditional matched OR, 0.14; exact 95% CI, 0.003-1.11), indicating substantial uncertainty in the safety comparison.
CONCLUSIONS: In this propensity score-matched retrospective cohort, robot-assisted FNS plus an additional CCS was associated with less femoral neck shortening, earlier full weight-bearing, shorter fracture-healing time, and better later functional recovery, at the cost of greater operative complexity. Because the safety analysis was underpowered and follow-up was limited to 12 months, these findings should be interpreted cautiously and do not establish long-term safety or femoral head necrosis risk; prospective multicenter studies with longer follow-up are required.