Adding a screw aimed at protecting the femoral neck during surgery for a distal femur fracture was not linked to a lower rate of later hip fracture on the same side, known as an ipsilateral fracture, according to a retrospective study. The rate was 1.2% among patients who received the extra fixation and 1.7% among those who did not, a difference that was not statistically significant, with a p-value of 0.691.
The comparison involved 395 patients treated at a single Level 1 tertiary trauma center between 2018 and 2024. The cohort included adults with selected distal femur fractures treated with operative fixation.
What the surgeons did
Among the 395 patients, 163 received prophylactic femoral neck screw fixation and the rest formed the comparison group. The added screw was placed into the femoral head through the upper part of a lateral plate, or with separate screws around the upper part of a retrograde intramedullary nail. The comparison group underwent distal femur fixation without an ipsilateral prophylactic femoral neck screw.
Researchers looked for a later same-side hip fracture documented in electronic medical records as having received surgical treatment. They also examined how long patients remained fracture-free over time. That analysis again found no significant difference between the groups, with a log-rank p-value of 0.802.
Six fractures shaped the result
Only six patients sustained a later hip fracture on the injured side, equal to 1.5% of the cohort. Two were in the prophylactic-fixation group and four were in the comparison group, and all six patients were female.
The small number of events limits how precisely the study can compare the two approaches. A post hoc calculation put the study’s achieved statistical power at just 7.1%, limiting its ability to detect a difference. The result therefore does not settle whether prophylactic fixation changes the risk of a later hip fracture.
Why the answer remains open
Surgeons chose whether to add the screw, so unknown differences between patients may have influenced the comparison. The groups were also different at the start. Women made up 81.0% of the prophylactic-fixation group and 68.5% of the group without it; periprosthetic fractures accounted for 65.0% versus 35.8%, and nail-plate combination constructs for 69.1% versus 26.4%.
The authors concluded that prophylactic screw placement was not associated with fewer subsequent same-side hip fractures and suggested that screw placement alone may not be independently protective. Because the study was observational and nonrandomized, it cannot establish that the screw itself caused any difference in risk.
More outcome events would be needed for a clearer answer. The low event count limits the study’s ability to detect differences, while surgeon discretion and the unequal patient mix make it difficult to separate the association with screw placement from other factors.
The study was submitted to and accepted by the institutional review board for human research. The authors reported no funding for the study or manuscript preparation and declared no conflicts of interest. The patient data are private and not publicly available, but can be made available upon reasonable request.
Paper data and sources
Original title: Prophylactic femoral neck fixation in distal femur fractures: evaluating protection against ipsilateral hip fracture.
Authors: Brian D Rust, Daniel E Pereira, David W Barton et al.
Journal/Repository: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
Status: Peer-reviewed
First online: 2026-08-21
DOI: 10.1007/s00590-026-04814-x
Original paper · Full text