Outcomes of Headed and Headless Cannulated Screws Fixation in Nondisplaced Femoral Neck Fracture

Background: The incidence of femoral neck fracture is increasing as society ages. Different types of cannulated screws can be used for internal fixation of femoral neck fractures, but no screw selection protocol has been determined to reduce the risk of operation failure. This retrospective study aimed to elucidate differences in outcomes between using cannulated compression screws and headless compression screws for fixation in nondisplaced femoral neck fractures. Methods: Adults aged 18 years and older with non-displaced femoral neck fracture, admitted between February 2016 and January 2022, and received fixation using three screws in an inverted triangle configuration were selected for this retrospective study. After exclusions, patients were separated into four groups based on using different combinations of headed cannulated compression screws and headless compression screws. Postoperative computerized tomography or magnetic resonance imaging was used to evaluate operation failure, defined as nonunion or avascular necrosis of the femoral head. Results: After exclusions, 153 patients (median age 75.0, range 65.0-85.0) with majority of females (69.9%) were included. While the combination of one cannulated compression screw (CCS) and two headless compression screws (HCS) did not achieve statistical significance compared to other screw configurations (P = 0.073), it still demonstrated the lowest rate of operative failure (0.0%). Age was identified as the only significant factor associated with operative failure (adjusted OR: 1.10; 95% CI: 1.03-1.17; P = 0.004). Conclusions: No significant differences are found in outcomes between different combinations of cannulated headed compression screws and headless compression screws in an inverted triangle configuration for fixation of non-displaced femoral neck fractures.