Fixing the Unfixable? Outcomes From Femoral Neck System Procedures in a Major Trauma Centre

Femoral neck fractures are common in the elderly and present significant treatment challenges due to the risk of avascular necrosis (AVN), particularly in displaced fractures. The Femoral Neck System (FNS) was developed to improve biomechanical stability and reduce AVN risk. However, concerns about a perceived high complication rate within our institution prompted a retrospective review of FNS outcomes over a five-year period. We retrospectively reviewed all patients who underwent FNS fixation for femoral neck fractures at Northern General Hospital from 2019 to 2024. Data collected included patient demographics, comorbidities, fracture classification, surgical timing, and postoperative outcomes, with particular attention to AVN and reoperation rates. Patients who died within 90 days postoperatively were excluded from specific outcome analyses. Seventy patients were identified, with 67 included in the final analysis. The mean patient age was 73.6 years. The overall complication rate was 22.4%, increasing to 25.9% after excluding early postoperative deaths. AVN accounted for 60% of all complications. Patients under 65 years experienced significantly higher complication (43.8%) and reoperation (37.5%) rates compared to those over 65 (19.0% and 16.6%, respectively). No statistically significant associations were found between complication rates and fracture displacement, injury mechanism, gender, or time to surgery. Comparatively, a previous departmental audit of cannulated hip screws in a similar over-65 cohort showed an 11.7% reoperation rate—4.9% lower than the FNS group. FNS fixation in femoral neck fractures was associated with a higher-than-expected rate of AVN and reoperation, particularly in younger patients. Despite its theoretical biomechanical benefits, the FNS does not appear to prevent biologically driven complications like AVN. Our department has since returned to using cannulated hip screws in most cases. Further prospective studies are needed to better define the role of FNS in contemporary femoral neck fracture management.