¹Department of Orthopaedics, Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
²Hubei Clinical Medical Research Center of Trauma and Microsurgery, Wuhan, China
³Elderly Hip Fracture Diagnosis and Treatment Center, Zhongnan Hospital of Wuhan University, Wuhan, China

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Objectives and questions: Despite the high incidence of femoral neck fractures, the optimal surgical strategy (surgical approach) for patients with difficult-to-reduce femoral neck fractures remains a controversial topic. This study aims to introduce a new open approach via the intertrochanteric line of the femur, utilizing Kirschner wire joystick technique to assist in the treatment of difficult-to-reduce femoral neck fractures with hollow screws.

Material and methods: A retrospective analysis was conducted on the clinical data of 52 patients with difficult-to-reduce femoral neck fractures who underwent anatomical reduction via the intertrochanteric line approach at Zhongnan Hospital of Wuhan University from March 2017 to March 2022. All patients were followed up regularly postoperatively, and the Garden index and Harris scores were recorded to evaluate the quality of femoral neck reduction and hip function. Imaging studies documented the fracture healing time, nonunion rate, avascular necrosis (AVN) of the femoral head, and other complications such as infection, thrombosis, and skin sensory abnormalities.

Results: Intraoperatively and postoperatively, all patients showed anatomical reduction of the fracture on X-ray fluoroscopy. All cases underwent BMP-2 implantation treatment. Postoperative X-ray evaluations of the femoral neck showed that 37 out of 52 (71.15%) patients achieved Grade I reduction, while 15 out of 52 (28.85%) achieved Grade II reduction. The average follow-up time for all patients was 32.37 months (ranging from 24 to 56 months). Fracture healing occurred in 49 out of 52 (94.23%) patients, with an average healing duration of 4.39 months (ranging from 3 to 6 months). No Trendelenburg gait was observed in any patient postoperatively. The overall incidence of AVN was 3 out of 52 (5.77%). According to the Harris hip function scores, 39 patients achieved excellent results (HHS ≥ 90), 7 had good results (80 ≤ HHS < 90), 3 had fair results (70 ≤ HHS < 80), and 3 had poor hip function (HHS < 70).

Discussion and conclusions: The intertrochanteric line approach is an effective, safe, and simple surgical method for femoral neck fractures. Through visualized operations and intraoperative exploration, it can provide good anatomical reduction, fracture stability, and repair of bone defects, while achieving internal fixation of screws within a single incision. Additionally, it can minimize potential complications, particularly the incidence of AVN and nonunion.

Figure 1 [Abb. 1]