From 2D to 3D: Evolution of evaluation methods for femoral neck fracture reduction quality

Femoral neck fractures (FNFs) represent a critical challenge in orthopedic trauma, characterized by high incidences of postoperative osteonecrosis of the femoral head (ONFH) and nonunion. For young patients and active elderly individuals, anatomic reduction and stable internal fixation remain the primary therapeutic goals. However, conventional assessment of reduction quality relies on two-dimensional (2D) fluoroscopic indices, which often lack the sensitivity to detect complex rotational or translational malalignment. Emerging three-dimensional (3D) digital techniques and robotic assistance offer superior spatial visualization and objective measurement frameworks. This review evaluates the evolution from classic 2D radiographic criteria to contemporary 3D digital assessment tools, discussing their clinical efficacy and potential for enhancing robotic-assisted surgical precision.