SYSTEMATIC REVIEW article
Front. Med.
Sec. Geriatric Medicine
Comparative Efficacy and Safety of Three Internal Fixation Strategies for Femoral Neck Fractures: A Network Meta-Analysis
Provisionally accepted
- 1Sichuan University West China Hospital Department of Orthopedic Surgery, Chengdu, China
- 2Sichuan University West China Hospital School of Nursing, Chengdu, China
- 3West China Hospital of Sichuan University Chinese Evidence-based Medicine Center, Chengdu, China
- 4Sichuan University West China School of Public Health, Chengdu, China
- 5Trauma center, West China Hospital of Sichuan University, Chengdu, China
- 6Department of Orthopedic Surgery, West China Fourth Hospital Sichuan University, Chengdu, China
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Background Currently, the most common internal fixation devices for femoral neck fractures are cannulated compression screws (CCS), dynamic hip screws (DHS), and femoral neck systems (FNS). However, no clear consensus exists regarding which device offers superior clinical efficacy and safety. Methods We systematically searched three databases (PubMed, Embase, and Cochrane Library) for clinical studies published from their inception until March 12, 2025. We included studies that directly compared the three internal fixation methods: FNS, DHS, and CCS. Outcomes of interest were analyzed using pairwise and network meta-analyses. Results This network meta-analysis included 23 studies comprising 55,910 patients. FNS demonstrated a statistically significant higher Harris Hip Score (MD 3.79, 95% CI 1.44 to 6.13) and a shorter fracture healing time (MD -1.00 months, 95% CI -1.53 to -0.48) compared to CCS. Both FNS and CCS were associated with lower rates of femoral head necrosis than DHS. CCS was superior to both FNS and DHS, showing significantly less intraoperative blood loss. Conclusion This network meta-analysis indicates that FNS may have advantages over CCS and DHS in fracture healing time and reduced risk of femoral head necrosis. Regarding Harris Hip Score, FNS was statistically superior to CCS, but the improvement did not reach the minimal clinically important difference, suggesting limited clinical meaningfulness. However, its definitive clinical superiority and optimal indications remain uncertain, necessitating further high-quality studies to validate its clinical value and guide practice.
Keywords: cannulated compression screws, Dynamic hip screws, Femoral Neck System, femoralneck fracture, internal fixation
Received: 06 Jan 2026; Accepted: 16 Feb 2026.
Copyright: © 2026 Liu, Mao, Zhao, Li, Chen, Chen and Pu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jialei Chen
Xiaobing Pu
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