Radiological Outcomes of Femoral Neck Fractures Treated with two Vs. Three Cannulated Screws in Adults

Abstract

Background: Femoral neck fractures are a very frequent type of orthopedic injury that, in most cases, lead to surgery as a way of restoring the stability of the hip and avoiding the development of complications related to the continuity of the fracture. Fixation with cannulated screws has gained wider acceptance because it is less invasive, and through this method, one can obtain a stable internal fixation. Nevertheless, the ideal number of screws that a surgeon should use in order to achieve a good fixation is always doubtful. Radiological examination is mainly used to check if the fracture has healed, if the alignment has been preserved, and if there are any complications after surgery.

Objective: In order to compare the post-operative radiological results of femoral neck fractures treated with either two or three cannulated screws in adult patients.

Methods: This case-control study was done at the Department of Orthopaedic Surgery, Hayatabad Medical Complex Peshawar, Pakistan, from January, 2025 to June, 2025. In total, 88 adult patients with femoral neck fractures were enrolled in the study and were separated into two groups. Group A comprised 44 patients who were operated on with two cannulated screws, while Group B included 44 patients operated on with three cannulated screws. Radiological parameters were evaluated with the help of postoperative and follow-up X-rays for the assessment of fracture union, preservation of alignment, screw migration, femoral head collapse, and failure of fixation. The analysis was done using SPSS, version 26, and a p-value of ≤0.05 was considered significant.

Results: Radiological union was noted in 79.5% of patients treated with two screws and 88.6% of patients treated with three screws. Postoperative complications, for example, femoral head collapse, screw migration, and fixation failure, occurred more often in the two-screw group than in the three-screw group. These results point to higher radiological stability obtained by using three cannulated screws.

Conclusion: Both fixation methods have been proven to work, and three cannulated screws yield better radiological outcomes and fewer complications than two-screw fixation.