Given the encouraging results of biomechanical studies on femoral neck fractures, are locking plates more safe?

This current study compares the clinical and radiological outcomes of femoral neck fractures in young adults treated with either cannulated screws (CS) or proximal femoral locking plates (PFLP). We conducted a retrospective study in patients aged 18 to 60 years with femoral neck fractures and investigated medical records between January 2005 and December 2016. Patients were divided into two groups based on implants, screw and plate, used for fixation assigned. In addition, two groups were compared for their complications and functional outcomes, which were assessed with Harris Hip Score (HHS) and Parker Palmer mobility scores. Sixty-nine of 104 patients met the inclusion criteria. Forty patients were treated with cannulated screws, while 29 were treated with a proximal femoral locking plate. The two groups were comparable in terms of their perioperative variables. The overall complication rate (screw group, n = 10; plate group, n = 14) and non-union rate were significantly high in the plate group (p < 0.05). Other complications did not show statistically significant differences. The screw group had better functional outcomes than the plate group, where only the Parker-Palmer mobility score comparison was significant (p < 0.05). Poor reduction quality and Pauwels' type III fractures were statistically associated with high complication rates regardless of the implants used (p < 0.05). Although PFLP showed better outcomes in biomechanical studies than CSs, we observed poorer clinical results. Therefore, although some of our results appeared to be statistically significant, reduction quality should also be considered.