Optimal technical factors during operative management of low-energy femoral neck fractures

Patrick C. Schottel, Michael Blankstein, Sheila Sprague, Marc Swiontkowski, Sofia Bzovsky, Mohit Bhandari, Emil H. Schemitsch

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


OBJECTIVE: To determine if cancellous screw (CS) and sliding hip screw (SHS) technical factors during low-energy femoral neck fracture fixation affects a 24-month revision surgery rate and health-related quality of life (HRQL).

DESIGN: Prospective randomized controlled study.

SETTING: International, multicenter.

PATIENTS: Eight hundred ninety-eight femoral neck fracture patients age 50 years and older.

INTERVENTION: Patients were randomized to fracture stabilization with either CSs or a SHS device as part of the Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial. CS technical factors analyzed included screw diameter, short versus long screw threads, screw number and formation, screw orientation, and washer use. SHS technical factors studied were side plate length, supplemental screw use, lag screw position, and tip-apex distance.

MAIN OUTCOME MEASUREMENTS: Revision surgeries within 24 months to promote fracture healing, relieve pain, treat infection, or improve function. In addition, HRQL measures were collected, including the SF-12 Physical Component Score and Western Ontario and McMaster Universities Osteoarthritis Index.

RESULTS: The 3-screw inverted triangle pattern had a significantly lower revision surgery rate than a 3-screw triangle formation (P = 0.004). No other CS or SHS technical factors were predictive of revision surgery or affected a patient's HRQL (P > 0.05).

CONCLUSIONS: A 3-screw inverted triangle pattern was superior to a 3-screw triangle formation. However, injury and patient factors such as fracture displacement, age, smoking status and sex play a more significant role in clinical outcomes for low-energy femoral neck fracture treatment.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)92-99
Number of pages8
JournalJournal of orthopaedic trauma
Issue number2
StatePublished - Feb 1 2021

Bibliographical note

Funding Information:
The FAITH study was supported by research grants from the Canadian Institutes of Health Research (MOP-106630 and MCT-87771), National Institutes of Health (1R01AR055267-01A1), Stichting NutsOhra (SNO-T-0602-43), the Netherlands Organization for Health Research and Development (80-82310-97-11032), and Physicians' Services Incorporated. M. Bhandari was also funded, in part, through the Early Research Award Program that provided funding for the FAITH study and by a Canada Research Chair in Musculoskeletal Trauma that is unrelated to the FAITH study (McMaster University, Hamilton, ON, Canada). Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number 1R01AR055267-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Research reported in this publication was also supported by The County Durham and Tees Valley Comprehensive Local Research Network that operates as part of the National Institute for Health Research Comprehensive Clinical Research Network in England. The funding sources had no role in design or conduct of the FAITH study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript.

Publisher Copyright:
© 2020 Wolters Kluwer Health, Inc.


  • Cancellous screw
  • Geriatric hip fracture
  • Sliding hip screw
  • Prospective Studies
  • Bone Screws
  • Humans
  • Middle Aged
  • Femoral Neck Fractures/diagnostic imaging
  • Fracture Fixation, Internal
  • Quality of Life
  • Treatment Outcome

PubMed: MeSH publication types

  • Randomized Controlled Trial
  • Multicenter Study
  • Journal Article


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