02/06/2026
Fixating Femoral Neck Fractures: The Art of Screw Configuration
Ever wondered how orthopedic surgeons choose where to place cannulated screws for a femoral neck fracture? It’s not just about putting hardware in; it's a precise game of biomechanics and structural support!
Here is a breakdown of what’s happening in this illustration:
The Foundation: Screws 1 & 2
First Screw (A): Placed inferiorly along the calcar (the thick plate of bone at the base of the femoral neck) on the anteroposterior (AP) view and midline on the lateral view. This provides the crucial base support.
Second Screw (B): Placed higher up at the midneck level on the AP view, but crucially angled along the posterior cortex on the lateral view to resist bending and rotational forces.
The Configurations: 3 vs. 4 Screws
Depending on the fracture pattern and bone quality, surgeons typically choose one of these geometric layouts (shown in cross-section views C & D):
Inverted Triangle Configuration (C): The gold standard for most stable femoral neck fractures. Placing one screw inferiorly (1st) and two screws superiorly (2nd & 3rd) creates a strong tripod effect that prevents the femoral head from tilting or rotating.
Diamond Configuration (D): Sometimes, an additional 4th screw is added anteriorly or superiorly to provide extra stability, especially in unstable, comminuted, or vertical fracture lines (like Pauwels Type III).
Every millimeter counts when it comes to preserving blood supply and ensuring optimal bone healing.
