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Title: Screw trajectory affects screw cut-out risk after fixation for nondisplaced femoral neck fracture in elderly patients
Authors: Wu, Y
Leu, TH
Chuang, TY
Ho, WP
Chen, YP
Lin, CY 
Keywords: Femoral neck fracture
Parallel screws
Screw fixation
Screw trajectory
Issue Date: 2019
Publisher: Hong Kong Academy of Medicine Press
Source: Journal of orthopaedic surgery, 7 Apr. 2019, v. 27, no. 2, p. 1-7 How to cite?
Journal: Journal of orthopaedic surgery 
Abstract: Background: Incidence of femoral neck fracture has risen with the aging of the population and has critical implications with regard to patient death, functional dependence, and social costs. Screw fixation using triangular configurations and calcar placement are still the preferred treatment for nondisplaced femoral neck fracture, to reduce the risk of loss of reduction and nonunion. However, this method is still controversial in terms of the effects of screw trajectory, including parallel or nonparallel configurations, on fixation of femoral neck fractures. This study aimed to compare the incidence of complications between patients who have undergone fixation with a parallel or a nonparallel screw trajectory.
Methods: We retrospectively analyzed 55 patients who were older than 60 years and diagnosed with nondisplaced femoral neck fracture from March 2014 to March 2016, and who were treated with cannulated screw fixation in our institution. Patient demographics, radiographic parameters including reduction quality, screw trajectory, and complications during the follow-up period were all evaluated.
Results: The overall complication rate for screw fixation in elderly patients was 23.6%, and screw cut-out was the most common complication, occurring in 14.5% of all enrolled patients. Also, we found that screw cut-out occurred in more osteoporotic patients, and all screw cut-outs were in groups treated with a nonparallel screw trajectory. However, parallel screw fixation was inclined to back out more after fracture healing and had a lower risk of postoperative screw cut-out. Conclusions: Our results suggested that fixation with nonparallel screws for nondisplaced femoral neck fracture in elderly and osteoporotic patients might interfere with shortening of the femoral neck along with fracture healing, leaving patients at risk of postoperative screw cut-out from the femoral head.
ISSN: 1022-5536
DOI: 10.1177/2309499019840252
Rights: © The Author(s) 2019
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (
The following publication Wu, Y., Leu, T.-H., Chuang, T.-Y., Ho, W.-P., Chen, Y.-P., & Lin, C.-Y. (2019). Screw trajectory affects screw cut-out risk after fixation for nondisplaced femoral neck fracture in elderly patients. Journal of Orthopaedic Surgery, 2309499019840252, 1-7 is published by Sage and is available at
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