Does Preoperative CT Improve Outcomes in Femoral Neck Fracture Fixation? A Retrospective Study

Background/Objectives: Femoral neck fractures are a growing concern due to their increasing incidence in both elderly and younger populations. Preoperative CT scan evaluation is often used for better understanding of fracture patterns of femoral neck fractures that need to be treated using cannulated screws. Methods: The present study retrospectively analyzed 55 patients treated with cannulated screw fixation over seven years. Preoperative CT scans, fracture classification (Garden and Pauwels), and surgical timing were evaluated. Results: All 55 patients were treated with three cannulated screws by nine fellowship-trained surgeons. The average age of the CT-yes group was 54.44 years (SD 15.45), while the average age of the CT-no group was 56.93 (SD 14.95). Differences in age among the two groups were not statistically significant. In 4 patients, the treatment with cannulated screws failed, leading to a subsequent total hip arthroplasty for avascular necrosis (AVN). Three of them belonged to the CT-yes group, while only one belonged to the CT-no group. A statistical analysis showed no significant differences between patients who underwent a CT scan and those who did not have a CT scan and their results (p = 0.282). Results indicate no statistically significant difference in outcomes between patients who underwent a CT scan before the surgical treatment and those who did not, while a well-conducted X-ray assessment is essential and can be sufficient to fully understand and treat most of the fractures. Conclusions: The risks of avascular necrosis and non-union must be considered in the decision-making process regarding the suitable treatment. Early surgery did not significantly improve treatment results, but it is recommended. Fixation with cannulated screws remains a good treatment, especially for some patterns of fractures and younger patients. Given the study's limitations, including the small sample size and retrospective nature, prospective multicenter studies are warranted to better understand the role of CT scans in optimizing surgical planning and improving patient outcomes.