A comparative study on the clinical efficacy and complications of proximal femoral nail antirotation and femoral neck system in the treatment of basicervical femoral neck fracture (AO/OTA 31-B3)

Abstract

Basicervical femoral neck fractures (FNFs) are prone to internal fixation failure owing to their inherent biomechanical instability. This study compares the efficacy of femoral neck system (FNS) and proximal femoral nail anti-rotation (PFNA) in treating basicervical FNF. A retrospective analysis was conducted on 99 patients with basicervical FNF admitted to fuzhou second general hospital from January 2020 to June 2024. Patients were divided into two groups based on the internal fixation method used: the FNS group (53 cases, average age 63.83 ± 18.80 years) and the PFNA group (46 cases, average age 69.78 ± 16.65 years). Main observation indicators included reduction quality and internal fixation-related complications, while secondary indicators included tip-apex distance, surgical time, occult blood loss, wound length, postoperative hospital stay, mortality, and Harris hip score. The average follow-up time was 24.03 ± 9.4 months. Preoperative data were comparable between groups ( P > 0.05). The PFNA group had a significantly lower overall incidence of implant-related complications than the FNS group (2.17% vs. 16.98%, P = 0.035), and the distribution of implant-related complication subtypes also differed significantly between groups ( P = 0.042). No significant differences were observed in fracture reduction quality, tip-apex distance, postoperative hospital stay, or mortality ( P > 0.05). The FNS group had significantly shorter incision length (4.60 ± 1.01 cm vs. 7.76 ± 1.32 cm, P < 0.001), less hidden blood loss (204.91 ± 61.66 ml vs. 391.27 ± 136.71 ml, P < 0.001), and shorter surgical time (0.62 ± 0.20 h vs. 0.70 ± 0.23 h, P = 0.048). In the full-cohort analysis including all patients with available HHS data, the Harris Hip Score was significantly higher in the PFNA group than in the FNS group (92.52 ± 4.15 vs. 89.28 ± 5.78, P = 0.002). After excluding patients with internal fixation failure, the result remained consistent, with the PFNA group showing a significantly higher HHS than the FNS group (92.78 ± 3.81 vs. 90.37 ± 4.35, P = 0.005). For AO/OTA 31-B3 basicervical FNF, PFNA was associated with fewer implant-related complications and higher final follow-up HHS than FNS. The HHS result remained consistent after excluding patients with internal fixation failure. Considering the retrospective design and the small number of complication events, PFNA may be considered a favorable fixation option, but these findings should be validated in larger prospective studies.