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Eight patients with varying Garden and Pauwel fracture types were treated, and technical precision—central implant placement, bi-cortical distal fixation, and controlled valgus alignment—strongly influenced union, function, and complication 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Reports 2025 December:15( 12) :Page 366-371   \nFrom Valgus-impacted to Displaced: Clinical and Technical Lessons in Femoral Neck Fracture Fixation with the Femoral Neck System  \nT K Jeejesh Kumar¹, Ramesh Govindharaaju¹, K Kumaran Chettiar¹, N SAkshay Kumar¹, HM Muhammad Adil¹  \nLearning Point of the Article:  \nMeticulous surgical technique – especially maintaining central implant placement, bi-cortical distal fixation, and slight valgus alignment – is crucial for optimal outcomes and minimizing complications in femoral neck fracture fixation using the Femoral Neck System.  \nAbstract  \nIntroduction: Femoral neck fractures continue to challenge orthopedic surgeons due to their complex biomechanics, high shear stresses, and risk of avascular necrosis (AVN) or non-union. The Femoral Neck System (FNS) is a relatively newer fixed-angle device designed to enhance stabilitywhile minimizing soft-tissue damage. This case series presents our clinical experience with the FNS across a spectrum of femoral neck fractures, focusing on technical nuances and lessons that influenced our patients’outcomes.  \nCase Series: Eight patients (aged 24–66 years) with femoral neck fractures of varying Garden and Pauwel types were managed with the FNS. Fracture patterns ranged from stable valgus-impacted to high-energy displaced fractures, including cases with concomitant pelvic or shaft injuries. Stable, valgus-impacted fractures treated with in situ fixation and minimal compression consistently achieved union and excellent function by3 months. Displaced and vertical fractures united reliably when near-anatomical or valgus reduction with central implant placement and bi-cortical distal fixationwas achieved. Technical errors such as anterior or eccentric boltplacement, unicortical distal locking, or correction ofvalgus to neutral alignment were associated with complications including varus collapse, implant back out, and neck shortening. One young patient developed AVN followinghigh-energy trauma despite satisfactory fixation.  \nConclusion: The FNS offers astable and minimally invasive option for femoral neck fracture fixationwhen applied with precise technique and respect for fracture morphology in selected cases. In situ or slight valgus fixation, especially in osteoporotic bone, yields superior outcomes due to the FNS’s invasive nature, avoidance of rotational torque to the at-risk head fragment and retention of the inherently stable valgus or neutral alignment. Complications were largely attributable to mechanical and technical factors rather than implant design, highlighting the importance of meticulous surgicalplanning and execution and careful patientselection.  \nKeywords: Femoral neck system, femoral neck fracture, internal fixation, avascular necrosis,varus collapse.  \nIntroduction  \nAdult femoral neck fractures are commonly encountered hip injuries, especially in the elderly and can cause significant morbidity if not managed appropriately. The management protocol varies according to the age of the patient, status of  \nmedical co-morbidities, time since injury, and many other factors. Although there is no set age limit, younger patients are given a trial of fracture fixation initially, as the femoral neck has a higher healing potential in younger patients, and if the fixation fails, a secondary replacement surgery is stillpossible without the  \n\n| \u003Cbr>Access this article online\u003Cbr>\u003Cbr>Website: [www.jocr.co.in](www.jocr.co.in)\u003Cbr>\u003Cbr>DOI:\u003Cbr>[https://doi.org/10.13107/jocr.2025.v15.i12.6562](https://doi.org/10.13107/jocr.2025.v15.i12.6562) | Author’s Photo Gallery |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n|  | | \u003Cbr>Dr. Ramesh Govindharaaju | \u003Cbr>Dr. K Kumaran Chettiar | | \u003Cbr>Dr. H M Muhammad Adil |\n|  | \u003Cbr>1Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India.\u003Cbr>Address of Correspondence:\u003Cbr>Dr. Ramesh Govindharaaju, Department of Orthopaedics, Government Medica","cbCaibxnQXTV11Xt","https://ap.wps.com/l/cbCaibxnQXTV11Xt","pdf",8299526,"English","# Learning Point of the Article\n# Abstract\n# Introduction\n# Case Series\n# Conclusion\n# Keywords","[{\"question\":\"What is the key surgical technique highlighted for the Femoral Neck System?\",\"answer\":\"Meticulous technique is emphasized, particularly maintaining central implant placement, bi-cortical distal fixation, and slight valgus alignment to optimize outcomes and limit complications.\"},{\"question\":\"How did fracture stability and reduction affect union outcomes?\",\"answer\":\"Stable valgus-impacted fractures treated with in situ fixation and minimal compression achieved union and excellent function by 3 months, while displaced and vertical fractures united when near-anatomical or valgus reduction with central implant placement and bi-cortical distal fixation was achieved.\"},{\"question\":\"Which technical errors were linked to postoperative complications?\",\"answer\":\"Complications were associated with anterior or eccentric bolt placement, unicortical distal locking, and correction of valgus to neutral alignment, leading to issues such as varus collapse, implant back-out, and neck shortening.\"}]","From Valgus-impacted to Displaced - Clinical and Technical Lessons in Femoral Neck Fracture Fixation with the Femoral Neck System | PDF",1790731448,15]