Comparative evaluation of the results of osteosynthesis of femoral neck fractures using the biplane double support screw fixation and the standard technique of three parallel screws

Introduction. Femoral neck fractures (FNF) are a complex problem in traumatology, especially in an ageing population. Despite the widespread use of osteosynthesis with three parallel cannulated screws, the complication rate remains high. The biplane double support screw fixation (BDSF) method proposed by O. Filippov has shown promising results in foreign studies, but has not been used or studied in the Russian Federation.

The aim of the study was to evaluate the effectiveness of the BDSF method in comparison with standard osteosynthesis in the treatment of FHF fractures.

Materials and methods. A comparative study of 78 patients with femoral neck fractures (Garden types I-IV) was conducted. The patients were divided into two groups: 1st (n=38) – osteosynthesis using the BDSF method; 2nd (n=40) – osteosynthesis with three parallel screws. To simplify the BDSF surgical technique, an original guide device was developed. The assessment included clinical and functional indicators (HHS scale, VAS) and radiological criteria up to 12 months.

Results. The frequency of consolidation in the BDSF group was 89.4% versus 75% in the comparison group (p<0.001). The average fusion time was significantly shorter in the 1st group (4.1±2.4 months versus 6.3±2.9 months; p<0.001). Cervical shortening >5 mm was observed in 26.3% of patients after BDSF and in 55% after standard osteosynthesis (p=0.002). The incidence of aseptic necrosis of the femoral head was lower in the BDSF group (5.2% vs. 17.5%; p=0.001). Functional results at 12 months on the HHS scale were comparable, but the BDSF group showed a tendency towards better scores (89.6±4.7 points vs. 82.7±7.4 points).

Conclusion. Osteosynthesis of femoral neck fractures using biplane double support screw fixation is an effective and safe alternative to the standard technique. The BDSF method allows for a higher frequency and faster consolidation times, as well as significantly reducing the risk of key complications such as varus collapse, neck shortening, and aseptic necrosis. The developed guide device optimises the implementation of the technique.

The results obtained justify the feasibility of introducing the BDSF method into widespread clinical practice in the Russian Federation.

1. Johnell O., Kanis J.A. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2018;17(12):1726–1733.

2. Cooper C. et al. Hip fractures in the elderly: A world-wide projection. Osteoporos Int. 1992;2:285–9.

3. Filipov O. Biplane Double-Supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes. Journal of the American Academy of Orthopaedic Surgeons. 2019;11:507–515.

4. Giordano V., Paes R.P., Alves D.D. Stability of L-shaped and inverted triangle fixation assemblies in treating Pauwels type II femoral neck fracture: a comparative mechanical study. Eur J Orthop Surg. 2018;28:1359–1367.

5. Hu J., Feng Z.M., Gao Z., Wu J. Clinical Outcome of Femoral Neck System Versus Cannulated Compression Screws for Fixation of Femoral Neck Fracture in Younger Patients. Journal of Orthopaedic Surgery and Research. 2021;16–2021:370–373.

6. Jilani L.Z., Abbas M.B., Ahmad S. Hip fractures and area level socioeconomic conditions: a population-based study. BM Outcomes of BDSF technique for osteosynthesis of femoral neck fractures. Int J Burn Trauma. 2023;13(3):149-155.

7. Lee, Y.K. Kim J.W., Lee M.H. Trend in the age-adjusted incidence of hip fractures in South Korea: Systematic review. Clin. Orthop. Surg. 2020;9:420–423.

8. Overmann A.L., Richards J.T., O’Hara N.N. Outcomes of elderly patients with nondisplaced or minimally displaced femoral neck fractures treated with internal fixation: A systematic review and meta-analysis. Injury. 2019;50:2158–2166.

9. Lagergren J., Mцller M., Rogmark C. Displaced femoral neck fractures in patients 60–69 years old-treatment and patient reported outcomes in a register cohort. Injury. 2020;51:11-19.

10. Li N., Cheng K.Y., Fan J. Evaluating three internal fixation techniques for Pauwels III femoral neck fractures via finite element analysis. Scientific Reports. 2024;14:155-9.

11. Kale A., Chalak A., Vatkar J.K., Dey K. Limitations and Complications in Treating Femoral Neck Fractures With the Femoral Neck System: A Case Report. Journal of Orthopaedic Case Reports. 2024;14:78–82.

12. Hoshino C.M., Christian M.W., O’Toole R.V. Fixation of displaced femoral neck fractures in young adults: fixed-angle devices or Pauwel screws? / Injury. 2016;47:1676–1684.

13. He C.Y., Lu C.Y., Wang Q. Comparison of the Clinical efficacy of a Femoral Neck System Versus Cannulated Screws in the Treatment of Femoral Neck Fracture in Young Adults. BMC Musculoskeletal Disorders. 2021;22:994-998.

14. Filipov O., Gueorgiev B., Sommer C. Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients. Arch Orthop Trauma Surg. 2017;137(6):779–788.

15. Fan X. Bio-mechanical effects of femoral neck system versus cannulated screws on treating young patients with Pauwels type III femoral neck fractures: A finite element analysis. BMC Musculoskelet. Disord. 2024;25:83-89.

16. Filipov O., Gueorguiev B. Unique stability of femoral neck fractures treated with the novel biplane double-supported screw fixation method: a biomechanical cadaver study. Injury. 2015;46(2):218–226.

17. Filipov O. Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck. Eur J Orthop Surg Traumatol. 2011;21(7):539–543.

18. Zlowodzki M., Brink O., Switzer J. et al. The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip. J. Bone Joint Surg. 2008;90-B:1487–1494.

19. Патент №202516487 «Направляющее устройство для проведения спицы при остеосинтезе переломов шейки бедренной кости» от 26.11.2025. Patent №202516487 «Napravlyayushcheye ustroystvo dlya provedeniya spitsy pri osteosinteze perelomov sheyki bedrennoy kosti» ot 26.11.2025. (In Russ.)