Wider screw spread can reduce the risk of short-term femoral head necrosis by optimizing the fixation stability in femoral neck fracture patients with triangle cannulated screw fixation.

BackgroundFixation instability serves as an initial trigger for femoral head necrosis in patients with femoral neck fractures undergoing internal fixation. The configuration of screw trajectories is critical in determining the stability of the fixation. Our previously published study indicates that abduction of screw trajectories may enhance postoperative angular stability. However, the effectiveness of a wider screw distribution on the sagittal plane in optimizing fixation stability and reducing the risk of femoral head necrosis remains uncertain.MethodsThis retrospective study reviewed imaging data from patients with femoral neck fractures who were treated with inverse triangle cannulated screw fixation. Postoperative lateral radiographs were used to evaluate the screw configuration strategy. The distance between the two cranial screws and the femoral neck width at its narrowest point were measured. The ratio of these two measurements was calculated to represent the screw spread grade. Demographic and imaging parameters were compared between patients who developed femoral head necrosis and those who did not. Regression analysis was conducted to identify potential risk factors associated with femoral head necrosis. Additionally, numerical models were employed to simulate the biomechanical impact of variations in screw spread grade.ResultsThe clinical analysis revealed that a lower screw distance-to-femoral width ratio was associated with a higher incidence of femoral head necrosis. This ratio was also identified as an independent risk factor for femoral head necrosis. Biomechanical simulations corroborated these findings, demonstrating that models with a lower screw-to-femoral width ratio exhibited reduced fixation stability and increased stress distribution.ConclusionsWider distribution of screws along the sagittal plane may significantly mitigate the risk of femoral head necrosis by enhancing fixation stability. The optimization of screw trajectories, particularly through broader screw spacing facilitated by a navigation system, emerges as a promising strategy for improving the local biomechanical environment and reducing the likelihood of femoral head necrosis.

ObjectiveTo investigate the risk factors for osteonecrosis of the femoral head (ONFH) after the treatment of femoral neck fracture in patients under 60 years old.MethodsA total of 250 cases of femoral neck fracture treated at 3 hospitals in Xuzhou from January 2002 to January 2016 were studied. The patients were followed up for 1~15 years, and the clinical data on femoral head necrosis after the femoral neck operation were analysed retrospectively. Risk factors were recorded, including age, gender, preoperative traction, time from injury to operation, reduction method, type of reduction, BMI, ASA classification, and quality of reduction. Logistic regression analysis was used to evaluate the independent risk factors for ONFH after treatment of femoral neck fracture.ResultsThe duration of follow-up was 1~15 years, with an average of 7.5 years. None of the 250 patients had fracture non-union, but 40 (16%) had necrosis of the femoral head. The time to necrosis of the femoral head was 1~7 years after the operation, with an average of 3.8 years. Univariate analysis showed that the type of fracture, the quality of reduction, the removal of internal fixation, BMI and ASA classification were risk factors affecting necrosis of the femoral head in patients with femoral neck fracture, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that internal fixation, fracture type (displacement), reduction quality (dissatisfaction), BMI (> 25), and ASA grade (III + IV) were independent risk factors affecting femoral head necrosis in patients with femoral neck fracture.ConclusionA variety of high-risk factors for femoral head necrosis are present after surgery with hollow compression screws for femoral neck fracture in adults. Removal of internal fixation, type of fracture, quality of reduction, BMI, and ASA classification were the most important risk factors influencing the development of femoral head necrosis. During treatment, there should be some targeted measures to reduce the incidence of necrosis of the femoral head.

To explore the risk factors of early femoral head necrosis in patients with femoral neck fracture after operation, and to establish a nomogram prediction model. A total of 167 patients with femoral neck fracture from January 2020 to April 2022 were selected and divided into necrosis group and non-necrosis group according to whether femoral head necrosis occurred in the early postoperative period. There were 21 males and 17 females in the necrosis group, aged from 33 to 72 years old, with an average of (53.49±10.96) years old, and the time from injury to operation ranged from 40 to 67 hours, with average time of(53.46±7.23) hours. There were 72 males and 57 females in the non-necrosis group, aged from 18 to 83 years, with an average of (52.78±12.55) years old, and the time from injury to operation was 18 to 65 hours, with an average time of(39.88±7.79) hours. The potential influencing factors, including patient gender, diabetes mellitus, hypertension, chronic liver disease, posterior inclination angle of the femoral head, operation mode, fracture displacement, fracture line location, preoperative braking traction, screw arrangement mode, reduction quality, age, body mass index(BMI), and injury to operation time were subjected to single factor analysis. Logistic multivariate regression analysis was conducted for factors with a significance level of P<0.05. The incidence of femoral head necrosis in 167 patients with femoral neck fracture was 22.76%. The following factors were identified as independent risk factors for early postoperative femoral head necrosis in patients with femoral neck fractures:coexisting diabetes[OR=5.139, 95%CI(1.405, 18.793), P=0.013], displaced fracture [OR=3.723, 95%CI(1.105, 12.541), P=0.034], preoperative immobilization[OR=3.444, 95%CI(1.038, 11.427), P=0.043], quality of reduction [OR=3.524, 95%CI(1.676, 7.411), P=0.001], and time from injury to surgery[OR=1.270, 95%CI(1.154, 1.399), P=0.000]. The Hosmer-Lemeshow goodness-of-fit test(χ2=3.951, P=0.862), the area under the receiver operator characteristic(ROC) curve was 0.944[P<0.001, 95%CI(0.903, 0.987)], with a sensitivity of 89.50%, the specificity was 88.40%, the maximum Youden index was 0.779, and the overall trend of the model correction curve was close to the ideal curve. Model regression equation was Z=1.637 × diabetes + 1.314× fracture displacement+1.237 × preoperative braking traction+1.260 × reduction quality + 0.239×injury to operation time-18.310. The occurrence of early femoral head necrosis in patients with femoral neck fracture postoperatively is affected by multiple factors. The risk early warning model established according to the factors has good predictive efficacy.

BackgroundThe clinical outcome of a new fixation device (femoral neck system, FNS) for femoral neck fractures remains unclear. The main purpose of this study was to evaluate two different internal fixation methods for the treatment of femoral neck fractures in patients aged under 60 years.MethodsWe retrospectively studied patients who underwent internal fixation surgery in our hospital for femoral neck fractures between January 2017 and January 2020. Cannulated compression screws (CCS) and FNS groups were divided according to different internal fixation methods. General data (such as sex, age, body mass index, type of fracture) of all patienFemoral neck shorteningts were collected, and joint function was evaluated using the Harris Hip Score (HHS) before and 1 year after surgery. We recorded related surgical complications, including femoral head necrosis, nonunion, and femoral neck shortening.ResultsThere were no significant differences in age, sex, or body mass index between the two groups. There was no statistical difference in HHSs between the two groups before surgery. Patients who underwent FNS treatment had longer surgery time (79.75 ± 26.35 min vs. 64.58 ± 18.56 min, p = 0.031) and more blood loss (69.45 ± 50.47 mL vs. 23.71 ± 28.13 mL, p < 0.001). The degree of femoral neck shortening in the FNS group was significantly lower than that in the CCS group (10.0% vs 37.5%, p = 0.036). Regarding postoperative complications, there was no statistical difference in the incidence of femoral head necrosis and fracture nonunion between the two groups.ConclusionPatients younger than 60 with femoral neck fractures can obtain satisfactory clinical results with CCS or FNS treatment. FNS has excellent biomechanical properties and shows significantly higher overall construct stability.

Necrosis of the femoral head is the main complication in femoral neck fracture patients with triangle cannulated screw fixation. Instant postoperative fixation instability is a main reason for the higher risk of femoral head necrosis. Biomechanical studies have shown that cross screw fixation can effectively optimize fixation stability in patients with proximal humerus fractures and pedicle screw fixation, but whether this method can also effectively optimize the fixation stability of femoral neck fractures and reduce the corresponding risk of femoral head necrosis has yet to be identified. In this study, a retrospective review of imaging data in femoral neck fracture patients was performed. The cross angle between the femoral neck and the caudal cannulated screw was reported; if the angle between the screw and the transverse plane increased, it was recorded as positive; otherwise, it was recorded as negative. Angle values and their corresponding absolute values were compared in patients with and without femoral head necrosis. Regression analysis identified potential risk factors for femoral head necrosis. Moreover, the biomechanical effect of the screw–femoral neck angle on fixation stability was also verified by numerical mechanical simulations. Clinical review presented significantly larger positive angle values in patients with femoral head necrosis, which was also proven to be an independent risk factor for this complication. Moreover, fixation stability progressively deteriorated with increasing angle between the caudal screw and the transverse plane. Therefore, increasing the angle between the caudal screw and the transverse plane may aggravate the risk of femoral head necrosis by deteriorating the fixation stability in patients with femoral neck fracture.

Objective To investigate the reasons of the extraction of internal fixation after the healing of femoral neck fracture leading to femoral head necrosis. Methods A total of 43 patients with the healing of femoral neck fracture who were extracted the internal fixation in Third People's Hospital of Mianyang were followed up.The incidence of femoral head necrosis with the factors such as the patient's age, gender, the timing to extract the internal fixation, bone graft in the channel of screws or not and the way to bear the weight after the extraction of internal fixation were compared. Results After an average of 2.5 years of follow-up, there were 15 cases of femoral head necrosis, the incidence of femoral head necrosis of the age of 40-59 years old and 60 to 83 years old was 12.5%(2/16), 48.1%(13/27) respectively, the difference was significant(χ2=5.6205, P<0.05). The incidence of femoral head necrosis of<2 years of follow-up and ≥2 years of follow-up was 52.2%(12/23), 15.0%(3/20) respectively, the difference was significant(χ2=6.508, P<0.05). The incidence of femoral head necrosis of the patients who had no bone graft in the channel of screws and were protected to bear the weight in 4-8 weeks(an average of 6 weeks) after the extraction of internal fixation and then fully weight-bearing was 52.6%(10/19), and of the patients who had bone graft in the channel of screws and didn't to bear the weight in 12 weeks after the extraction of internal fixation and then gradually increased to full weight-bearing was 20.8%(5/24), the difference was significant(χ2=4.720, P<0.05). Conclusion For the elder patients, the extraction of internal fixation may increase the risk of the femoral head necrosis, they are recommended to preserve the internal fixation.The timing to extract the internal fixation should be above 2 years; the solution that bone graft in the channel of screws and don't to bear the weight in 12 weeks after the extraction of internal fixation and then gradually increased to full weight-bearing, can obviously reduce the incidence of femoral head necrosis. Key words: Femoral neck fracture; Femoral head necrosis; The extraction of internal fixation

Objective To study the therapeutic effect of partial gluteus medius-ilium flap in reconstruction of the blood supply to the femoral head and neck to treat femoral neck fracture and femoral head necrosis in young and middle-aged adults. Methods From June 2004 to December 2009, we treated 20 patients with femoral neck fracture and femoral head necrosis. They were 15 men and 5 women, aged from 25 to 56 years (mean, 38. 6 years). In the 10 cases of femoral neck fracture (group A), there were 7 men and 3 women, and 2 Garden type Ⅱ, 5 type Ⅲ and 3 type Ⅳ fractures. The duration from injury to surgery averaged 14. 3 days (from 11 to 23 days). In the 10 cases of femoral head necrosis (group B), there were 8 men and 2 women, and 6 ones of Ficat phase Ⅱ and 4 ones of phase Ⅲ. Group A were treated with reduction and hollow nail fixation. Group B were treated with removal of the necrotic bone and graft of iliac spongy bone.Partial gluteus medius-ilium flaps were used in both groups to reconstruct the blood supply to the femoral head and neck. Results The 20 patients were followed up for one to 5 years (mean, 3. 1 years). In group A,all fractures healed and the average Harris hip score 3 months postoperation was 92 (range, 81 to 97) .Femoral head necrosis occurred in one case. In group B, the symptoms were greatly improved and the average Harris hip score 3 months postoperation was 84 (range, 73 to 95). Deterioration was found in 3 cases, 2 of which had to sustain hip replacement. Conclusion The partial gluteus medius-ilium flap is effective in reconstruction of the blood supply to the femoral head and neck, because it keeps abundant blood supply, and is simple, safe and reliable to handle without sacrificing function of the gluteus medius. Key words: Femur head necrosis; Femoral neck fractures; Transplants; Blood supply reconstruction

To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture, and analyze their indications. From June 2015 to December 2020, 21 patients with ipsilateral femoral shaft and femoral neck fracture were treated, including 14 males and 7 females, aged 23 to 69 years old with an average of(38.1±12.9) years old. According to different femoral shaft fracture sites, some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure, InterTan or PFNA Ⅱ), some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft (dual structure), and postoperative function and complications were recorded during follow-up. In 10 cases of single-structure fixation, the femoral necks were all basicervical fractures, and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation, 9 cases in 11 were basal type of femoral neck, 2 cases in 11 were neck type, and the femoral shaft fractures were located in the isthmus and the distal isthmus. All patients were followed up for 12 to 27 months. No femoral head necrosis, deformity, delay or nonunion occurred in the patients with single-structure fixation, and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up, Harris score of patients with single-structure fixation was 91.8±4.1, with 8 cases were excellent and 2 cases were good. The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis, except 1 case of femoral shaft fracture had delayed union;At the final follow-up, Harris score of patients with dual-structure fixation was 92.4±5.9, 7 cases were excellent, 3 cases were good, and 1 case was fair. Good reduction and fixation is the key to the treatment of such fractures. Both the single-structure fixation and the dual-structure fixation are good methods, and it should be selected according to the locations of femoral shaft and femoral neck fractures. Single-structure fixation is a good choice for femoral shaft fractures located at the proximal isthmus and basal femoral neck fractures. For isthmus and distal femoral shaft fractures combined with ipsilateral femoral neck fractures, dual-structure fixation is recommended.

IntroductionPathological fractures of the femoral neck caused by necrosis of the femoral head are extremely rare. Here, we report a rare case of bilateral femoral head osteonecrosis extending to the femoral neck, with bilateral pathological fractures of the femoral neck occurring within a short period of time.Case reportA 65-year-old male with a 25-year history of daily consumption of 750 ml of liquor, presented with right hip pain after labor for 1 month. He subsequently sustained a right femoral neck fracture without trauma and underwent a right total hip arthroplasty. Two months later, he suffered a non-traumatic left femoral neck fracture and underwent a left total hip arthroplasty. Histopathological examination revealed osteonecrosis of the femoral head and neck, along with the presence of osteoclasts and granulomatous inflammation. Bone mineral density testing also showed osteoporosis. The bilateral femoral neck fractures were ruled out to be caused by any other pathological factors.DiscussionThis is the first report of pathological fractures of the bilateral femoral neck caused by femoral head necrosis. During the literature review process, we found that this case conforms to the histological characteristics of rapidly destructive hip disease and analyzed the etiology of femoral head necrosis and the pathogenesis of femoral neck fractures.

The stability of internal fixation of femoral neck fractures can be obtained through surgical techniques, the configuration of screws and bone grafting, etc. However, the blood supply injury caused by fractures could not be completely reversed by the current medical management. Hence, the comprehensive evaluation of the residual blood supply of the femoral neck, to perioperatively avoid further iatrogenic injury, has become a hotspot. The anatomy of the extraosseous blood supply of the femoral neck has been widely reported, while its clinical application mostly involved the assessment of the medial circumflex femoral artery and retinacular arteries. However, further studies are needed to explore the prognosis of patients with these artery injuries, with different degrees, caused by femoral neck fractures. Direct observations of nutrient foramina in vivo are not possible with current clinical technologies, but it is possible to make reasonable preoperative planning to avoid subsequent femoral head necrosis based on the distribution features of nutrient foramina. The anatomy and clinical application studies of the intraosseous blood supply focused on the junction area of the femoral head and neck to probe the mechanism of femoral head necrosis. Thus, the intraosseous blood supply of other regions in the femoral neck remains to be further investigated. In addition, a blood supply evaluation system based on a three-level structure, extraosseous blood vessels, nutrient foramina, and intraosseous vascular network, could be explored to assist in the treatment of femoral neck fractures.

Objective To investigate the methods and results of lengthened proximal femoral nail antirotation (PFNA) in the treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures. Methods Of the 21 patients with femoral shaft combined with ipsilateral femoral neck fractures treated by lengthened PFNA from 2006 to 2009,16 patients with complete follow-up were retrospectively studied.There were 15 males and 1 female,at mean age of 35 years (range,21-51 years).Injury causes were all high-energy trauma including traffic injuries in 11 patients and fall injuries in five.According to Garden classification,there were seven patients with type Ⅰ femoral neck fractures,six with type Ⅱ and three with type Ⅲ.Femoral shift fractures contained six superior part fractures and nine medial part fractures and one inferior part fracture.According to Winquist classification,there were two patients with type Ⅰ femoral shaft fractures,four with type Ⅱ,six with type Ⅲ and four with type Ⅳ.Two patients had open fractures belonging to type Ⅰ Gustilo-Anderson.Harris hip score was used to evaluate functional outcomes at the last follow-up postoperatively. Result The mean follow-up time was 2.4years (range,1-4 years ).The mean period for healing of femoral neck and shaft fractures was 4.2months ( range,3-6 months) and 5.1 months ( range,3-8 months) respectively.Four patients showed delayed diagnoses of femoral neck fractures ; two patients had delayed union of femoral shaft fractures ; one suffered from avascular necrosis of the femoral head ; one patient presented 3 cm of extension of the affected limb and was accompanied by active pain of the knee joint for over four months.According to Harris score,function of hip joints was excellent in seven patients,good in six and fair in three,with excellence rate of 82％. Conclusions It is relatively few that the femoral shaft fracture is combined with ipsilateral femoral neck fracture.The rate of missed diagnosis of femoral neck fractures is high and the patients with high energy trauma hould be highly paid attention to.Lengthened PFNA conforms to characteristics of biomechanical fixation and presents short operation time and solid fixation. Lengthened PFNA achieves affirmatory effects for treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures. Key words: Femoral fractures; Femoral neck fractures; Fracture fixation,internal

Objective To study the effect of open reduction and internal fixation with closed reduction and internal fixation on femoral head necrosis and fracture healing rate. Methods Selected 68 cases of femoral neck fracture as the research objects, the patients were randomly divided into open reduction group and closed reduction group, 34 cases in each group, the functional recovery, fracture healing and necrosis of the femoral head were compared between the two groups. Results The excellent rate of functional recovery of open reduction group was 79.4%, which was slightly lower than that of closed reduction group (88.2%), but the difference was not significant (P>0.05). The nonunion rate of the open reduction group was 20.6%, which was slightly higher than that of the closed reduction group (14.7%), but the difference was not significant (P>0.05). The rate of necrosis of the femoral head in the open reduction group was 29.4%, which was significantly lower than that of the closed reduction group (P<0.05). Conclusions Open reduction and internal fixation with closed reduction and internal fixation in the treatment of femoral neck fracture, with a higher reduction quality, can reduce the incidence of femoral head necrosis, it is worthy of clinical application and promotion. Key words: Open reduction; Closed reduction; Fracture fixation; Femoral head necrosis; Fracture healing

Objective To explore the association between the spatial displacements in the three-dimensional reconstruction of femoral neck fracture and avascular necrosis of femoral head after internal fixation. Methods One hundred and sixty-three patients with femoral neck fracture were included in this study who had been treated at our institute between January 2010 and January 2013. They were 61 males and 102 females, with an average age of 55.7 years. By Garden classification, 20 cases were type Ⅰ, 30 type Ⅱ, 57 type Ⅲ and 56 type Ⅳ. All their preoperative and postoperative primitive CT data were imported to Mimics 10.01 software for three-dimensional reconstruction of femoral neck fractures in which the spatial displacement parameters (the lowest displacement at the dimple, central displacement, and spatial displacement angle) were measured. The patients were divided into 2 groups according to presence or absence of postoperative avascular necrosis of femoral head. The 2 groups were compared in terms of demographic data, preoperative and postoperative spatial displacement parameters. Multivariate logistic regression analysis was performed to explore the risk factors of avascular necrosis of femoral head. Results The average duration of follow-up was 3.1 years (range, from 2.5 to 5.4 years) . Avascular necrosis of femoral head was found in 33 cases (20.2%) . There were significant differences between the necrosis and necrosis-free groups in preoperative Garden classifications, all the preoperative and postoperative spatial displacement parameters (the lowest displacement at the dimple, central displacement, and spatial displacement angle) (P<0.05) . Multivariate logistic regression analysis showed that preoperative spatial displacement parameters of the femoral head, preoperative Garden classification of the fracture, and postoperative spatial displacement parameters of the femoral head were associated with avascular necrosis of femoral head (P<0.05). Conclusions Three-dimensional reconstruction of femoral neck fracture can accurately assess preoperative displacements and postoperative reduction. Preoperative displacement of the femoral head, fracture classification and postoperative reduction are the major risk factors for incidence of femoral head necrosis. Key words: Femoral neck fractures; Imaging, three-dimensional; Photogrammetry; Femur head necrosis

Objective To investigate the postoperative long-term efficacy and related factors of postoperative complications of femoral neck fracture. Methods A total of 103 patients of femoral neck fracture fresh and closed were collected from January 2010 to September 2012.Follow-up observation was performed on 82 cases with complete data of more than five years after operation. Gender, age, injury violence, Garden type, the number of cannulated screws, operation method, Garden index, ambulation time, whether to internal fixation removal, Harris score and femoral neck nonunion, femoral head necrosis and shortening of the femoral neck are counted.Logistic regression was used to analyze these factors. Results The mean age of 82 patients was(49±6)years and the average follow-up was (77±4) months. There were 31 cases of femoral head necrosis and necrosis rate was 37.8%. Asymptomatic rate was 54.84% among them. Eleven cases occurred femoral neck nounion in which 10 cases accepted the total hip replacement, and the nounion rate was 13.41%. In 35 cases, the femoral neck was shortened with a short shrinkage of 42.68%. At the end of the follow-up, the good rate of Harris score was 71.08%. Analysis of related risk factors of femoral head necrosis showed that the injury violence[OR=0.029, 95%CI (0.003, 1.336), P=0.005], Garden type[OR=18.27, 95%CI (1.547, 215.77), P=0.021], surgical methods[OR=8.567, 95%CI(1.739, 42.204), P=0.008] and reduction quality [OR=0.125, 95%CI (0.024, 0.657), P=0.014] were significant. The results of the nonunion of the femoral neck (Wald χ2=4.471, P=0.034) and the results of the femoral neck shortening (Wald χ2=10.255, P=0.001) showed that the reduction quality was significant influence factor. Conclusions Efffect of cannulated screw internal fixation treatment of femoral neck fracture after long-term follow-up is satisfaction, but the incidence of shortening of the femoral neck is high.The reduction quality is significantly associated with these three complications. Key words: Femoral neck fractures; Fracture fixation, internal; Femur head necrosis; Fractures, ununited; Treatment outcome

Background: There are no long-term studies regarding the clinical effectiveness of a novel fixation technique (femoral neck system [FNS]) for femoral neck fractures. The primary aim of this study was to compare the effectiveness of two internal fixation techniques (FNS and cannulated compression screw [CCS]) for treating femoral neck fractures in individuals between the ages of 20 and 40 years. Materials and Methods: Data of patients who underwent internal fixation surgery for femoral neck fractures in our hospital between January 2018 and January 2020 with CCS and between January 2020 and January 2022 with FNS were retrospectively evaluated. The groups of CCS and FNS were separated based on the various internal fixation techniques. Demographics about all patients, including sex, age, body mass index, and fracture type were recorded. Pre-operative and 1-year post-operative follow-up of patients was to assess femoral neck shortenings and the Harris Hip score was used to evaluate joint function. Post-operative complications such as femoral head necrosis, non-union, and femoral neck shortening were noted. Results: 30 patients each of CCS and FNS system fixation were enrolled in the study. The male-to-female ratio was 21:9 and 18:12 for CCS and FNS, respectively. The average age of both groups was around 30 years. Compared to patients treated with CC screws, patients who had FNS treatment required less time to recuperate and resume normal activities. The HSS score improvement at 2 weeks and 12 weeks was significantly better in the FNS system than CCS fixation. There was improvement in flexion, abduction, and external rotation range of motion in FNS compared to CCS. There was no statistically significant difference between the two groups in the incidence of femoral head necrosis or fracture non-union following surgery. Conclusion: Patients treated with FNS for femoral neck fractures in the age range of 20–40 years can achieve better hip scores than CCS fixation and also have improved range of motion in flexion, abduction, and external rotation. Keywords: Femoral neck system, cannulated cancellous screw, femoral neck fractures, harris hip score