Prospective study of femoral neck system fixation combined with enhanced recovery after surgery for the treatment of unstable intracapsular femoral neck fracture

Prospective study of femoral neck system (FNS) vs. cannulated compression screw (CCS) fixation has not been appropriately reported. We prospectively investigate the efficacy of FNS vs. CCS fixation combined with ERAS in the treatment of unstable intracapsular FNF. 70 consecutive patients with unstable intracapsular femoral neck fracture met the inclusion criteria were randomly divided into FNS group and CCS group (each 35 cases). ERAS was applied in both groups. The perioperative period and follow-up results were compared. The operation time, fluoroscopy time, fracture reduction quality and follow-up time were not significantly different between the two groups (P > 0.05). The blood loss in the FNS group was significantly more than that in CCS group whereas the time to start weight-bearing, fracture healing time, internal fixation failure in the FNS group were significantly less than those in the CCS group (P < 0.05). The neck shortening and revision surgery of the FNS group showed a trend of superiority to CCS group but the difference was not significantly different (P > 0.05). The AVN in the two groups was similar. At the last follow-up, the Harris hip score in the FNS group was higher than that in the CCS group (P < 0.05). Hence, FNS fixation with ERAS for FNF can provide earlier weight-bearing, fewer complications related to the implant, faster healing and better functional recovery than CCS fixation with ERAS, which is consistent with the better biomechanical properties of FNS.