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Background <p>The treatment of femoral neck fractures (FNF) using cannulated screws in young patients frequently presents complications. This study aimed to examine the relationship between prognosis and cannulated screw fixation positioning in young patients with subcapital or transcervical FNF of Garden type Ⅲ or Ⅳ, Pauwels Angle &lt; 50°.</p> Methods <p>Patient records from 2012 to 2021 were obtained from the First Affiliated Hospital of Wenzhou Medical University. The analysis included patient demographics, medical history, fracture classification, X-ray imaging, and cannulated screw positioning. Outcome measures comprised reoperation, nonunion, or osteonecrosis of the femoral head within a 2-year follow-up period. Statistical analyses, including Chi-square tests, rank sum tests, logistic regression analysis, and receiver operating characteristic curves, were conducted on 186 cases from 2012 to 2019 to develop a prognostic scoring system. This system was compared with the established Schep scoring system. Subsequently, 30 patients from 2019 to 2021 were utilized to validate the diagnostic efficacy of the prognostic scoring system.</p> Results <p>The analysis identified six prognostic factors: tip-head distance (0–15&#xa0;mm, <i>P</i> = 0.006, Odd Ratio (OR) = 1.233, 95% Confidence Intervals (CI): 1.062–1.432), distance to the superior cortex (0–6&#xa0;mm, <i>P</i> = 0.045, OR = 1.207, 95% CI:1.004–1.452), distance to the inferior cortex (0–6&#xa0;mm, <i>P</i> = 0.003, OR = 1.456, 95% CI:1.141–1.859), the angle between implants in lateral view (&lt; 6°, <i>P</i> = 0.012, OR = 1.208, 95% CI:1.042-1.400), the position of screw in anterior posterior view (inferior 74%, <i>P</i> &lt; 0.001, OR = 0.826, 95% CI:0.746–0.915), and the position of screw in lateral view (posterior 70%, <i>P</i> = 0.005, OR = 0.915, 95% CI:0.861–0.973). The Schep scoring system showed no statistically significant differences (<i>p</i> &gt;0.05). A 6-point prognostic model incorporating these factors was developed. Patients scoring 5–6 demonstrated superior prognosis compared to those scoring 0–2 and 3–4. The model’s high diagnostic value was subsequently confirmed using 30 patients from 2019 to 2021(AUC = 0.926, 95%CI = 0.836-1.000).</p> Conclusions <p>This research established cannulated screw positioning as a significant prognostic factor in young patients. The newly developed prognostic model shows promise in identifying prognostic-related risks, though additional validation with larger cohorts is required.</p>

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Development and testing of a prognostic scoring system for screw-positioning related femoral neck fracture failures for younger adults

  • 期刊论文

  • 发表日期：

    2026年2月11日

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  • Zhibiao Bai,
  • Hongming Meng,
  • Liangyan Chen,
  • Shaohao Wu,
  • Zeyu Shou,
  • Han Zhou,
  • Chengwei Xu,
  • Xiaojing Huang,
  • Chun Chen

摘要

Background

The treatment of femoral neck fractures (FNF) using cannulated screws in young patients frequently presents complications. This study aimed to examine the relationship between prognosis and cannulated screw fixation positioning in young patients with subcapital or transcervical FNF of Garden type Ⅲ or Ⅳ, Pauwels Angle < 50°.

Methods

Patient records from 2012 to 2021 were obtained from the First Affiliated Hospital of Wenzhou Medical University. The analysis included patient demographics, medical history, fracture classification, X-ray imaging, and cannulated screw positioning. Outcome measures comprised reoperation, nonunion, or osteonecrosis of the femoral head within a 2-year follow-up period. Statistical analyses, including Chi-square tests, rank sum tests, logistic regression analysis, and receiver operating characteristic curves, were conducted on 186 cases from 2012 to 2019 to develop a prognostic scoring system. This system was compared with the established Schep scoring system. Subsequently, 30 patients from 2019 to 2021 were utilized to validate the diagnostic efficacy of the prognostic scoring system.

Results

The analysis identified six prognostic factors: tip-head distance (0–15 mm, P = 0.006, Odd Ratio (OR) = 1.233, 95% Confidence Intervals (CI): 1.062–1.432), distance to the superior cortex (0–6 mm, P = 0.045, OR = 1.207, 95% CI:1.004–1.452), distance to the inferior cortex (0–6 mm, P = 0.003, OR = 1.456, 95% CI:1.141–1.859), the angle between implants in lateral view (< 6°, P = 0.012, OR = 1.208, 95% CI:1.042-1.400), the position of screw in anterior posterior view (inferior 74%, P < 0.001, OR = 0.826, 95% CI:0.746–0.915), and the position of screw in lateral view (posterior 70%, P = 0.005, OR = 0.915, 95% CI:0.861–0.973). The Schep scoring system showed no statistically significant differences (p >0.05). A 6-point prognostic model incorporating these factors was developed. Patients scoring 5–6 demonstrated superior prognosis compared to those scoring 0–2 and 3–4. The model’s high diagnostic value was subsequently confirmed using 30 patients from 2019 to 2021(AUC = 0.926, 95%CI = 0.836-1.000).

Conclusions

This research established cannulated screw positioning as a significant prognostic factor in young patients. The newly developed prognostic model shows promise in identifying prognostic-related risks, though additional validation with larger cohorts is required.