Shortening after femoral neck fracture fixation: is there a solution?

When using parallel screws for treatment of femoral neck fractures, shortening of the femoral neck might occur. Given the high revision surgery rates associated with parallel screws, we developed a questionnaire to explore (1) surgeons' viewpoints on difficulties in the fixation of femoral neck fractures, (2) their perception of the clinical importance of femoral neck shortening after internal fixation, and (3) their opinions regarding the ideal fixation device. Two hundred three surgeons responded. Eighty-three percent believed shortening of the femoral neck is common after screw fixation of femoral neck fractures; 89% believed shortening limits hip abductor function; and 69% believed shortening limits patients' physical function. When asked for features of the ideal implant for treatment of a femoral neck fracture, allowing compression across the fracture site on insertion and providing angular stability with a fixed-angle device to minimize shortening of the femoral neck were favored by 89% and 79% of the respondents, respectively. A plate with multiple nonparallel lag screws that can be locked into the plate might be a solution. However, the findings of this study are surgeons' opinions, which may or may not be confirmed by scientific evidence.