Clinical outcomes and learning curve of robot-assisted percutaneous cannulated screw fixation for femoral neck fractures
- 1Department of Orthopedics, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
- 2Department of Orthopedics, Combat-Trauma Treatment Center, General Hospital of Central Theater Command, Wuhan, Hubei, China
Abstract
BackgroundRobot-assisted cannulated-screw fixation may improve trajectory control and reduce fluoroscopic acquisitions during femoral neck fracture treatment; however, its comparative clinical benefits and early learning curve remain insufficiently characterized.MethodsThis single-centre retrospective cohort study included 61 patients aged 18–65 years with acute Pauwels type II or III femoral neck fractures treated between January 2023 and January 2025. Twenty-one patients underwent robot-assisted fixation and 40 underwent conventional freehand fixation with three cannulated screws. Perioperative, radiographic, and 12-month clinical outcomes were compared. The learning curve was assessed using Spearman rank correlation, simple linear regression, and mean-centred cumulative sum (CUSUM) analysis.ResultsBaseline characteristics were comparable between groups. Compared with conventional freehand fixation, robot-assisted fixation was associated with shorter total operative time., fewer fluoroscopic acquisitions.., and lower intraoperative blood loss… Robot-assisted fixation was associated with more favourable screw-placement parameters and less femoral-neck shortening. Postoperative day-1 pain scores assessed using VAS were lower in the robot-assisted group. HHS values were higher at 1 month and final follow-up. Fracture-healing time and neck–shaft angle did not differ significantly between groups. Only one postoperative complication occurred during follow-up, consisting of screw back-out in one patient in the freehand group; therefore, comparative safety conclusions were not supported. Within the robot-assisted cohort, case number was inversely associated with total operative time, puncture workflow time, and fluoroscopy use. The mean-centred CUSUM trajectories reached sample-specific maxima at cases 7, 6, and 6, respectively, before showing overall downward trajectories.ConclusionRobot-assisted percutaneous cannulated-screw fixation was associated with greater procedural efficiency and more favourable screw-placement parameters than conventional freehand fixation. Statistically significant differences were observed in postoperative pain, HHS, and femoral-neck shortening; however, the clinical importance of these differences remains uncertain. Operative performance improved across the observed sequence of robot-assisted cases, although no validated proficiency threshold could be established from this cohort.
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BibTeX
@article{gong2026clinical,
title = {{Clinical outcomes and learning curve of robot-assisted percutaneous cannulated screw fixation for femoral neck fractures}},
author = {Hu Gong and Yang Shu and Te Li and Jibin Chen and Fanghui Zhang},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1980063},
url = {https://doi.org/10.3389/fsurg.2026.1980063},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinical outcomes and learning curve of robot-assisted percutaneous cannulated screw fixation for femoral neck fractures
AU - Hu Gong
AU - Yang Shu
AU - Te Li
AU - Jibin Chen
AU - Fanghui Zhang
PY - 2026
DA - 2026/10/26
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1980063
UR - https://doi.org/10.3389/fsurg.2026.1980063
AB - BackgroundRobot-assisted cannulated-screw fixation may improve trajectory control and reduce fluoroscopic acquisitions during femoral neck fracture treatment; however, its comparative clinical benefits and early learning curve remain insufficiently characterized.MethodsThis single-centre retrospective cohort study included 61 patients aged 18–65 years with acute Pauwels type II or III femoral neck fractures treated between January 2023 and January 2025. Twenty-one patients underwent robot-assisted fixation and 40 underwent conventional freehand fixation with three cannulated screws. Perioperative, radiographic, and 12-month clinical outcomes were compared. The learning curve was assessed using Spearman rank correlation, simple linear regression, and mean-centred cumulative sum (CUSUM) analysis.ResultsBaseline characteristics were comparable between groups. Compared with conventional freehand fixation, robot-assisted fixation was associated with shorter total operative time., fewer fluoroscopic acquisitions.., and lower intraoperative blood loss… Robot-assisted fixation was associated with more favourable screw-placement parameters and less femoral-neck shortening. Postoperative day-1 pain scores assessed using VAS were lower in the robot-assisted group. HHS values were higher at 1 month and final follow-up. Fracture-healing time and neck–shaft angle did not differ significantly between groups. Only one postoperative complication occurred during follow-up, consisting of screw back-out in one patient in the freehand group; therefore, comparative safety conclusions were not supported. Within the robot-assisted cohort, case number was inversely associated with total operative time, puncture workflow time, and fluoroscopy use. The mean-centred CUSUM trajectories reached sample-specific maxima at cases 7, 6, and 6, respectively, before showing overall downward trajectories.ConclusionRobot-assisted percutaneous cannulated-screw fixation was associated with greater procedural efficiency and more favourable screw-placement parameters than conventional freehand fixation. Statistically significant differences were observed in postoperative pain, HHS, and femoral-neck shortening; however, the clinical importance of these differences remains uncertain. Operative performance improved across the observed sequence of robot-assisted cases, although no validated proficiency threshold could be established from this cohort.
SN - 2296-875X
ER -