Osteosynthesis of Stable Femoral Neck Fractures by Cancellous Screws or Angle-Stable Device: A Comparison between Two Medical Centers

Background: Femoral neck fractures are common in the elderly. These fractures are known to increase mortality by 5-8 folds. Traditionally, the surgical treatment of non-displaced femoral neck fractures (Garden 1 or 2) consists of osteosynthesis by 3 cancellous screws. In recent years, a new implant, the angle-stable device, has been introduced.
The benefits of this implant in the treatment of non-displaced femoral neck fractures over cancellous screws have not been thoroughly tested.

Aim: The comparison of surgical outcomes and complication rates between the two implants for non-displaced femoral neck fractures from two medical centers, each using one implant exclusively.

Materials and methods: 55 adult patient records from "Rambam" hospital and 47 patient records from "Meir" were used in the years 2012-2013. Records were evaluated for length of surgical procedure, Hgb loss during surgery, rate of significant surgical complications (such as osteonecrosis or revision surgery), and mortality 1 year after surgery. Statistical analysis included chi-square and Mann-Whitney non-parametric tests.

Results: Mean age for patients from "Rambam" and "Meir" was 72.3 and 76.1 respectively (P value 0.233). Mean surgery time was 33.5 minutes for cancellous screws and 64.9 minutes for angle-stable device (P value 0.100). Mean hospitalization time post-surgery was 4.9 and 7.8 days for "Rambam" and "Meir" respectively (p value<0.005). One year mortality was 18.3% and 21.3% for "Rambam" and "Meir" respectively (with P value of 0.695). One patient from "Rambam" and 3 patients from "Meir" developed Osteonecrosis post op (p value 1.000).

Conclusions: We showed no superiority of either fixation method in terms of significant complications and revision surgery rates. When taking to consideration the shorter surgery time, length of hospitalization and reduced implant costs, we recommend the percutaneous cancellous screws fixation as the treatment of choice for non-displaced femoral neck fractures.