Research Article: Clinical efficacy of manual reverse closed reduction and robot-assisted cannulated screw fixation for valgus-impacted osteoporotic femoral neck fractures in the elderly: a retrospective cohort study
Abstract:
Achieving anatomical restoration in valgus-impacted femoral neck fractures remains a clinical challenge, particularly in the elderly. This retrospective study evaluated a “dual-optimization” strategy—integrating manual reverse closed reduction with robotic-assisted internal fixation—compared to conventional in-situ freehand fixation. Seventy-two patients were divided into the reduction-assisted (RA, n =?36) and in-situ freehand (IF, n =?36) groups. While the RA group required longer operative times (1.74?±?0.63?h vs. 1.29?±?0.37?h, p <?0.05), it demonstrated superior technical precision with significantly fewer fluoroscopy sessions (33.28?±?7.71 vs. 56.56?±?19.71) and guide-pin adjustments (0.17?±?0.38 vs. 1.89?±?1.09, p <?0.0001). Radiologically, the RA group achieved effective deformity correction (valgus and posterior tilt angles, p <?0.0001) and exhibited higher screw placement accuracy (5.92?±?3.75° vs. 11.14?±?5.28°) and superior screw dispersion (22.10?±?1.47% vs. 18.83?±?1.22%, p <?0.05). At 24–36 months follow-up, the RA group showed significantly less femoral neck shortening (2.5?±?2.1?mm vs. 9.1?±?3.8?mm, p <?0.0001) and higher Harris Hip Scores (82.00?±?11.44 vs. 73.61?±?15.07, p <?0.05). Furthermore, the RA group had markedly lower incidences of femoral head necrosis (5.56% vs. 25.00%), non-union (8.33% vs. 27.78%), and fixation failure (5.56% vs. 22.22%, p <?0.05). In conclusion, within the limitations of this cohort, combining manual reverse reduction with robotic assistance synergistically may provide clinical benefits by improving surgical precision and maintaining femoral neck anatomy, showing a positive tendency toward better functional recovery and reduced complications for geriatric valgus-impacted fractures.
Introduction:
Hip fractures represent one of the most debilitating osteoporotic injuries in the elderly population, with an incidence that is escalating significantly alongside the global trend of population aging ( 1 ). In 2021, the global age-standardized incidence of hip fractures was estimated at approximately 948 per 100,000 individuals ( 2 ). Femoral neck fractures account for 50%–60% of these cases, with valgus-impacted fractures, typically classified as Garden stage I, representing 5%–15% of all femoral neck injuries (…
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