ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicAdvances in Precision Medicine for Minimally Invasive Treatment of Pelvis/Hip Fractures: Integration of Digital and Intelligent TechnologiesView all 12 articles
Clinical and economic evaluation of robotic versus freehand screw fixation in femoral neck fractures: advancing precision alignment in orthopedics
Provisionally accepted
FAWWAZ AL-SMADI1
Sajeda Al-Smadi2Xudong Xie1Yanzhi Zhao1Jiewen Liao1Mengfei Liu1*
Bobin Mi1*
Guohui Liu1*- 1Huazhong University of Science and Technology Tongji Medical College Union Hospital, Wuhan, China
- 2Al-Balqa Applied University, As-Salt, Jordan
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Introduction: Femoral neck fractures are common and technically challenging injuries that often require internal fixation, with outcomes influenced by surgeon experience. This study compared clinical and economic outcomes of TiRobot-assisted versus freehand cannulated screw fixation, focusing on alignment precision and anatomical considerations to assess the role of robotics in enhancing accuracy in orthopedic care. Methods: This single-center retrospective cohort study included 50 adult patients with femoral neck fractures treated between July 2023 and March 2024 at Wuhan Union Hospital. Patients were followed for 12 to 20 months and evenly divided into two groups: TiRobot-assisted (n = 25) and traditional freehand fixation (n = 25). Intraoperative parameters (operative time, blood loss, fluoroscopy frequency, and screw accuracy) and postoperative outcomes (hip function, complications, hospital stay, and surgical cost) were analyzed using appropriate statistical tests. Results: Operative time was significantly shorter in the TiRobot group (68 ± 14 min) than in the traditional group (81 ± 23.5 min; p = 0.028). Blood loss (27.68 ± 12.99 vs. 49.8 ± 15.03 mL; p < 0.001) and fluoroscopy use (12.24 ± 1.94 vs. 20.24 ± 2.47; p < 0.001) were significantly reduced. Screw parallelism was notably better in both anteroposterior (p = 0.008) and lateral views (p = 0.010). At the 12-month follow-up, Harris hip scores were higher in the TiRobot group (94 ± 8.5 vs. 87 ± 13.5; p = 0.014). Time to discharge (5.01 ± 1.46 vs. 7.03 ± 1.86 days; p < 0.001) and total hospital stay (7 ± 3 vs. 8 ± 3 days; p = 0.039) were shorter. Surgical cost was higher in the TiRobot group (CNY 28,998.31 ± 4,659.88 vs. CNY 17,653.63 ± 4,461.55; p < 0.001). Conclusions: TiRobot-assisted fixation offers greater precision, reduced intraoperative trauma, and faster recovery. Though more costly, its clinical advantages support its role in anatomically-precise orthopedic surgery.
Keywords: Femoral Neck Fractures, Cannulated screw placement, Robotic Surgical Procedures, Surgical precision, precision alignment
Received: 05 Sep 2025; Accepted: 02 Dec 2025.
Copyright: © 2025 AL-SMADI, Al-Smadi, Xie, Zhao, Liao, Liu, Mi and Liu. 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:
Mengfei Liu
Bobin Mi
Guohui Liu
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