Is DHS with Fibular Strut Graft Superior for the Fixation of Comminuted Femoral Neck Fractures (FNF)? A Comparative Analysis with New Implant Femoral Neck System

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Abstract
Purpose The dynamic hip screw with fibular strut graft (DHS-FG) is a treatment method for femoral neck fractures (FNF) with multiple cortex comminution. Femoral neck systems (FNS) improve stability and prevent excessive neck shortening in FNFs. However, no comparative studies exist to determine method superiority. This study assesses the effectiveness and complications of DHS-FG versus FNS in treating comminuted FNFs. Methods Retrospective analysis of 50 patients (age 18–50) admitted to our institution with comminuted FNFs from January 2015 to March 2021. Patients were divided into 2 groups: DHS-FG (21 patients) and FNS (29 patients). Comparison parameters included operative time, intraoperative blood loss, fracture healing time, and complications (nonunion, neck shortening, avascular necrosis). Patient-reported outcomes were measured using Harris Hip Score at final follow-up. Results We followed all 50 patients for 24–72 months (mean 30 ± 2.07 months). There were no significant differences between the groups in age, gender, fracture classification, postoperative neck shaft angle, and tip-apex distance. However, the union rate differed significantly between DHS-FG and FNS groups (p < 0.05). Significant differences were also observed in surgical time (100 ± 9 vs. 76 ± 23 min), blood loss (370 ± 31 vs. 231 ± 123 ml), and complications (3 [14.2%] vs. 10 [34.4%]) in DHS-FG and FNS groups, respectively. Conclusion In comminuted FNFs, DHS-FG demonstrated superior union rates and lower complication rates than FNS. DHS-FG may be an effective treatment option for this fracture type, requiring further research to explore potential benefits and limitations of FNS in this context. Level of Evidence III. Level of Clinical Care Level I Tertiary trauma centre.

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