The Effect of Configuration of Rhombic Cannulated Screws on Internal Fixation of Femoral Neck Fractures

Femoral neck fractures are commonly encountered clinical problems, especially in patients with osteoporosis, and have high morbidity and mortality. Internal fixation of femoral neck fractures using 3 cannulated screws placed in an inverse triangle configuration is commonly performed. Recently, the use of 4 cannulated screws in a rhombic configuration has been proposed. The aim of this study was to investigate the outcomes of femoral neck fractures treated using either an inverse triangle or rhombic configuration to determine which had a better clinical prognosis. A total of 138 consecutive patients without any previous hip surgery who had femoral neck fractures treated with cannulated compression screws in either an inverse triangle or rhombic configuration were reviewed. Patients' demographic and radiological data were collected from the authors' institutional database. The authors found that the rhombic configuration did not have a better result in decreasing complications, such as femoral neck shortening or screw exit, or in Harris Hip Scores and other clinical prognoses compared with the inverse triangle configuration. In addition, the technique used for applying 4 screws (especially the posterior ones) needs to be improved, so until then, using 3 screws in an inverse triangle configuration remains the gold standard for the treatment of femoral neck fractures. [ Orthopedics . 2020; 43(2):e72–e78.]