Abstract
BACKGROUND: Pauwels type Ⅲ femoral neck fractures are characterized by poor stability and high postoperative complication rates, and the optimal internal fixation regimen remains to be verified. The aim of this study was to compare the effectiveness between simple cannulated screws internal fixation and cannulated screws combined with lateral femoral neck support plate internal fixation in the treatment of Pauwels type Ⅲ femoral neck fractures. METHODS: A retrospective analysis was performed on 68 patients with Pauwels type Ⅲ femoral neck fractures. Control group was treated with 3 cannulated screws internal fixation, and observation group was treated with lateral femoral neck support plate on the basis of control group. The operation time, intraoperative blood loss, hospitalization time, visual analogue scale (VAS) score, Harris Hip score (HHS) and postoperative complications were compared between two groups. RESULTS: The central finding of this study is that the observation group provided significantly superior patient-reported and functional outcomes. Regarding postoperative complications, including fracture nonunion, avascular necrosis of the femoral head, and wound infection, the incidence was lower in the observation group compared with the control group. Specifically, the observation group demonstrated markedly better hip function, with HHS significantly higher than the control group at both 3-month (68.35 ± 2.37 vs. 59.41 ± 2.55, P < 0.001) and 6-month (92.06 ± 2.46 vs. 80.03 ± 5.23, P < 0.001) follow-ups. Moreover, patients in the observation group experienced substantially less pain, as reflected by a significantly lower VAS score at the critical 6-month time point (0.47 ± 0.56 vs. 1.09 ± 0.67, P < 0.001). CONCLUSION: Compared with simple cannulated screws fixation, the combination of cannulated screws and a lateral femoral neck support plate provides more stable fixation, reduces postoperative pain, and facilitates faster recovery of hip joint function, without increasing the risk of complications. This approach allows for satisfactory fracture reduction and favorable functional outcomes, making it a reliable surgical strategy for the treatment of Pauwels type III femoral neck fractures.