Abstract
BACKGROUND: Managing femoral neck fractures (FNFs) in young adults remains a significant clinical dilemma. No single internal fixation method has demonstrated clear superiority. The aim of this study was to compare the clinical and radiographic outcomes of FNFs in young adults treated with femoral neck locking plate (FNLP) or conventional partially-threaded 6.5 mm multiple cannulated cancellous screws (MCCS). METHODS: A randomized controlled clinical trial (RCT) study was conducted on 74 patients to assess FNLP and MCCS in management of FNFs in young adults in Sohag university hospital between October 2022 and October 2024. The outcomes included Harris Hip Score (HHS), weight-bearing timelines, radiographic union times, and complication rates. RESULTS: FNLP demonstrated superior functional outcomes with significantly higher HHS scores compared to MCCS. Patients treated with FNLP achieved earlier partial and full weight-bearing (p <.001) and faster radiographic union times (p =.012), indicating better biomechanical stability. MCCS had a significantly shorter operative time at (49.3 ± 3.5 min) compared to the FNLP group at (62.3 ± 9.9 min), (p =.042). Complication rates, including femoral neck shortening, avascular necrosis, and infection, were comparable between the two groups. CONCLUSION: FNLP is a more effective fixation method for young adults with FNFs, offering faster functional recovery and improved radiographic outcomes. MCCS demonstrated significant shorter operative time which is a potential advantage especially in resources-constrained settings. Complication rates were similar between FNLP and MCCS, making MCCS a viable option in selected cases based on fracture severity, surgical expertise, and resources availability. LEVEL OF EVIDENCE: Level II therapeutic: prospective randomized controlled clinical trial. TRIAL REGISTRATION: The trial was retrospectively registered at 27 November, 2023 at www. CLINICALTRIALS: gov (Trial Registration Number: NCT06162637).