Comparison of the femoral neck system and dynamic hip screw for femoral neck fracture: A systematic review and meta-analysis

Introduction: Recently, the femoral neck system (FNS) has been introduced as a novel fixation device, especially for femoral neck fracture (FNF); however, whether it can replace the widely used dynamic hip screw (DHS) remains unclear. This study aimed to compare the perioperative characteristics and clinical outcomes of FNS and DHS in the treatment of FNF. Methods: This systematic review and meta-analysis followed the PRISMA-P guidelines. A comprehensive search of MEDLINE, Embase, and the Cochrane Library was conducted up to December 10, 2024. Comparative studies evaluating DHS and FNS for FNF were included. Data were extracted on perioperative surgical parameters, postoperative complications, and functional outcomes. Pooled effect sizes were calculated using a random-effects model. Results: Eight studies involving 726 patients were included. FNS was associated with significantly shorter operative time (mean difference: −19.68 minutes; 95% CI: −26.36 to − 13.00; P < .001) and lower intraoperative blood loss (mean difference: −16.89 mL; 95% CI: −20.88 to −12.90; P < .001). There was no significant difference between FNS and DHS in terms of femoral neck shortening, nonunion, or osteonecrosis of the femoral head. Functional outcomes measured by Harris hip score were significantly better in the FNS group (mean difference: −1.40; 95% CI: −2.57 to −0.23; P = .02). Conclusion: FNS demonstrated shorter operative time, reduced blood loss, and improved functional outcomes compared to DHS, with comparable complication rates. These findings suggest that FNS may serve as a viable alternative to DHS for the treatment of FNFs.