Femoral neck fractures treated with cannulated screws: can surgeons predict functional outcomes and minimize the risk of necrosis?

Main Article Content

Silvia De Franco
Edoardo Ipponi
Alfio Damiano Ruinato
Paolo Domenico Parchi
Lorenzo Andreani
Michelangelo Scaglione
Rodolfo Capanna


Femoral neck fractures, Cannulated Screws, Avascular Nerosis, Tobacco, Smoke


Background and aim: Femoral neck fractures are among the most frequent in mankind. Screw fixation is considered a suitable approach specially for undisplaced or slightly displaced fractures that occur to young patients. We conducted our study in order to evaluate both functional outcomes and complication rates of patients who received this treatment in our institution. A particular focus was given to the aseptic necrosis of the head, trying to identify if anamnestic, clinical or radiological data could play a significant role as prognostic factors.

Methods: For each case who was treated with screw fixation due to a femoral neck fracture, we recorded data regarding, among the others, BMI and whether they used tobacco products or corticosteroids on a regular basis. Necrosis of the femoral head and mechanical complications were recorded. Functional outcome was evaluated using the Harris Hip Score.     
Results: 74 cases were included in our study. The mean Harris Hip score was 89.5. Aseptic necrosis of the femoral head occurred in 9 cases (12.2%). Regular use of tobacco was associated with a higher risk to develop necrosis (p=0.007). The Body Mass Index was significantly higher in cases who had necrosis compared to the rest of our population (p=0.043) and was inversely proportional to the post-operative Harris hip score (p=0.001).

Conclusions: While considering screw fixation to treat cases with femoral neck fractures, patient’s weight and use of tobacco should be considered as prognostic factors.  (www.actabiomedica.it)


Download data is not yet available.
Abstract 112 | PDF Downloads 69


1. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018 Aug;49(8):1458-1460. doi: 10.1016/j.injury.2018.04.015. Epub 2018 Apr 20. PMID: 29699731.
2. Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P. Epidemiology of hip fractures: Systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr. 2019 Feb;52(1):10-16. doi: 10.1007/s00391-018-1382-z. Epub 2018 Mar 28. PMID: 29594444; PMCID: PMC6353815.
3. Xia Y, Zhang W, Zhang Z, Wang J, Yan L. Treatment of femoral neck fractures: sliding hip screw or cannulated screws? A meta-analysis. J Orthop Surg Res. 2021. 16, 54 (2021). DOI:10.1186/s13018-020-02189-1
4. Brox WT, Roberts KC, Taksali S, Wright DG, Wixted JJ, Tubb CC, et al. The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Management of Hip Fractures in the Elderly. J Bone Joint Surg Am. 2015 Jul 15;97(14):1196-9. doi: 10.2106/JBJS.O.00229. PMID: 26178894; PMCID: PMC6948785.
5. Zielinski SM, Meeuwis MA, Heetveld MJ, Verhofstad MH, Roukema GR, Patka P, et al. Dutch femoral neck fracture investigator group. Adherence to a femoral neck fracture treatment guideline. Int Orthop. 2013 Jul;37(7):1327-34. doi: 10.1007/s00264-013-1888-3. Epub 2013 Apr 18. PMID: 23595233; PMCID: PMC3685653.
6. Samsami S, Saberi S, Sadighi S, Rouhi G. Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations. J Med Biol Eng. 2015;35(5):566-579. doi: 10.1007/s40846-015-0085-9. Epub 2015 Oct 1. PMID: 26500470; PMCID: PMC4609309.
7. Johnson EO, Soultanis K, Soucacos PN. Vascular anatomy and microcirculation of skeletal zones vulnerable to osteonecrosis: vascularization of the femoral head. Orthop Clin North Am. 2004 Jul;35(3):285-91, viii. doi: 10.1016/j.ocl.2004.03.002. PMID: 15271536.
8. Tseng FJ, Chia WT, Pan RY, Lin LC, Shen HC, Wang CH, et al. Comparison of arthroplasty vs. osteosynthesis for displaced femoral neck fractures: a meta-analysis. J Orthop Surg Res. 2017 Sep 15;12(1):131. doi: 10.1186/s13018-017-0629-5. PMID: 28915928; PMCID: PMC5602948.
9. Heetveld MJ, Rogmark C, Frihagen F, Keating J. Internal fixation versus arthroplasty for displaced femoral neck fractures: what is the evidence? J Orthop Trauma. 2009 Jul;23(6):395-402. doi: 10.1097/BOT.0b013e318176147d. PMID: 19550224.
10. Parker MJ, Dynan Y. Is Pauwels classification still valid? Injury. 1998 Sep;29(7):521-3. doi: 10.1016/s0020-1383(98)00118-1. PMID: 10193494.
11. Liporace F, Gaines R, Collinge C, Haidukewych GJ. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am. 2008 Aug;90(8):1654-9. doi: 10.2106/JBJS.G.01353. PMID: 18676894.
12. Shen M, Wang C, Chen H, Rui YF, Zhao S. An update on the Pauwels classification. J Orthop Surg Res. 2016 Dec 12;11(1):161. doi: 10.1186/s13018-016-0498-3. PMID: 27955672; PMCID: PMC5154085.
13. Wang S, Li B, Zhang Z, Yu X, Li Q, Liu L. Early versus delayed hip reduction in the surgical treatment of femoral head fracture combined with posterior hip dislocation: a comparative study. BMC Musculoskelet Disord. 2021 Dec 20;22(1):1057. doi: 10.1186/s12891-021-04968-1. PMID: 34930251; PMCID: PMC8690980.
14. Duckworth AD, Bennet SJ, Aderinto J, Keating JF. Fixation of intracapsular fractures of the femoral neck in young patients: risk factors for failure. J Bone Joint Surg Br. 2011 Jun;93(6):811-6. doi: 10.1302/0301-620X.93B6.26432. PMID: 21586782.
15. Longstaff LM, Jain R, Schemitsch EH. Fixation of subcapital hip fractures in patients sixty years of age or less. JBJS. 2003. 85 (8), 1616–1617. doi: 10.2106/00004623-200308000-00039.
16. Papakostidis C, Panagiotopoulos A, Piccioli A, Giannoudis PV. Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome. Injury. 2015 Mar;46(3):459-66. doi: 10.1016/j.injury.2014.12.025. Epub 2015 Jan 3. PMID: 25616675.
17. Chassanidis CG, Malizos KN, Varitimidis S, Samara S, Koromila T, Kollia P, Dailiana Z. Smoking affects mRNA expression of bone morphogenetic proteins in human periosteum. J Bone Joint Surg Br. 2012 Oct;94(10):1427-32. doi: 10.1302/0301-620X.94B10.28405. PMID: 23015573.
18. Xu B, Anderson DB, Park ES, Chen L, Lee JH. The influence of smoking and alcohol on bone healing: Systematic review and meta-analysis of non-pathological fractures. EClinicalMedicine. 2021 Oct 31;42:101179. doi: 10.1016/j.eclinm.2021.101179. PMID: 34765953; PMCID: PMC8571530.
19. Wen Z, Lin Z, Yan W, Zhang J. Influence of cigarette smoking on osteonecrosis of the femoral head (ONFH): a systematic review and meta-analysis. Hip Int. 2017 Sep 19;27(5):425-435. doi: 10.5301/hipint.5000516. Epub 2017 May 29. PMID: 28574127.
20. Chang CJ, Jou IM, Wu TT, Su FC, Tai TW. Cigarette smoke inhalation impairs angiogenesis in early bone healing processes and delays fracture union. Bone Joint Res. 2020 May 16;9(3):99-107. doi: 10.1302/2046-3758.93.BJR-2019-0089.R1. PMID: 32435462; PMCID: PMC7229299.
21. Hou J, He C, He W, Yang M, Luo X, Li C. Obesity and Bone Health: A Complex Link. Front Cell Dev Biol. 2020;8:600181. Published 2020 Dec 21. doi:10.3389/fcell.2020.600181
22. Zhou L, Jang K, Moon YJ, Wagle S, Kim KM, Lee KB. Leptin ameliorates ischemic necrosis of the femoral head in rats with obesity induced by a high-fat diet. Sci Rep. 2015. 5, 9397. DOI: https://doi.org/10.1038/srep09397

Most read articles by the same author(s)

1 2 > >>