Reliable Fixation and Favorable Union Following Open Reduction and Internal Fixation Using Headless Cannulated Compression Screws in Pediatric Femoral Neck Fracture: A Case Report

Abstract

Pediatric femoral neck fractures are rare, accounting for less than 1% of pediatric fractures, but carry substantial risks of avascular necrosis (AVN), nonunion, and growth disturbance. Early diagnosis and stable fixation are essential, although the optimal fixation method in adolescents remains controversial. To describe the clinical and radiographic outcomes of open reduction and internal fixation using headless cannulated compression screws in an adolescent with a nondisplaced femoral neck fracture. A 13-year-old boy presented with acute right hip pain and inability to bear weight after falling from a bunk bed. Radiographs demonstrated a nondisplaced Garden type II femoral neck fracture. Open reduction and internal fixation were performed using three headless cannulated compression screws in a triangular configuration under fluoroscopic guidance. Anatomic reduction and stable fixation were achieved. A staged rehabilitation protocol was initiated postoperatively. Serial radiographs showed progressive fracture healing, with assisted ambulation at 3 months and full, pain-free hip function at 6 months. Accurate reduction and stable fixation are critical to prevent secondary displacement and minimize AVN risk. Headless cannulated compression screws provide interfragmentary compression, rotational stability, and minimal physeal disruption. In this case, timely surgery and stable fixation resulted in fracture union without complications.  Open reduction and internal fixation using headless cannulated compression screws achieved reliable union, preserved hip function, and avoided major complications, supporting its use as a treatment option for nondisplaced femoral neck fractures in adolescents.