Biplane Double-supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes

Osteosynthesis of femoral neck fractures is still associated with high complication rates. The novel method of biplane double-supported screw fixation offers better osteosynthesis stability by buttressing two of three medially diverging cannulated screws on the inferior neck cortex. Biomechanically, the most effective component of this fixation is the third, inferior obtuse screw, supported along considerable distance on both the inferior and posterior cortices of the femoral neck following its spiral anterior curve. Thus, biplane double-supported screw fixation achieves greater inferoposterior cortical support of the implants, allowing immediate full weight bearing for patients older than 55 years. Although the method has been recently communicated, some important surgical aspects still remain to be discussed. This report aims at describing a detailed and modified surgical technique and providing criteria and recommendations for its successful application according to the clinical experience over more than 9 years. LEVEL OF EVIDENCE: Level V, expert evidence