Precision reduction of femoral neck fractures: a novel strategy based on the femoral neck fracture morphology

In femoral neck fractures the secondary damage caused by repeated multiple reductions needs to be prevented. Accordingly, the aim of this study was to achieve an anatomical reduction in the first manipulation of reduction in femoral neck fractures. We propose a new reduction strategy using the x-ray morphology of femoral neck fractures for preoperative planning. In the present study we compared this approach to conventional operation procedures for the treatment of femoral neck fractures. From 2020 to 2021, 35 patients with femoral neck fractures were operated with this reduction strategy. Those were compared with 34 patients treated without the proposed preoperative method. All patients were compared for consistency between the preoperative assessment and the intraoperative execution of the reduction approach, number of reductions, operative time, number of fluoroscopies, intraoperative bleeding, and reduction quality. The operative time of patients in the study group was significantly shorter (38.40 ± 10.26 min) than that of the control group (47.26 ± 9.09 min), and the number of reductions [1.0 (1.0, 1.0)] was significantly less than that of the control group [2.0 (1.75, 2.25)]. The number of fluoroscopies (10.27 ± 2.84) was also significantly less than that of the control group (13.53 ± 2.59) times. The KAPPA value = 0.886 shows the good agreement between the preoperative proposed protocol and the intraoperative protocol about the study group .The bleeding, quality of repositioning, Harris Hip score, MOS 12-item Short Form Survey (SF-12), and early complication rate were not statistically different between the groups (P > 0.05). The selection of the appropriate repositioning method based on the analysis of femoral neck fracture X-ray morphology can improve the efficiency and accuracy of preoperative planning. This reduces the secondary damage that may be caused by multiple reduction, shortens the operation time and reduces the exposure to radiation.