Objective:

To evaluate the clinical and radiological efficacy of a dual-optimization strategy integrating manual reverse closed reduction with robotic-assisted internal fixation compared to conventional in-situ freehand fixation for valgus-impacted femoral neck fractures in elderly patients.

Approach:

• Study Design: Retrospective cohort study involving 72 patients with osteoporotic femoral neck fractures, divided into reduction-assisted (RA) and in-situ freehand (IF) groups.
• Inclusion/Exclusion Criteria: Included patients aged 60-75 with specific fracture types and bone mineral density criteria; excluded those with pathological fractures, joint history, severe health issues, or incomplete follow-up.

Key Findings:

• The RA group had longer operative times (1.74 h vs. 1.29 h, p < 0.05).
• The RA group required significantly fewer fluoroscopy sessions (33.28 vs. 56.56) and guide-pin adjustments (0.17 vs. 1.89, p < 0.0001).
• The RA group achieved better deformity correction and higher screw placement accuracy (5.92° vs. 11.14°, p < 0.05).
• At follow-up, the RA group showed less femoral neck shortening (2.5 mm vs. 9.1 mm, p < 0.0001) and higher Harris Hip Scores (82.00 vs. 73.61, p < 0.05).
• Lower incidences of femoral head necrosis (5.56% vs. 25.00%), non-union (8.33% vs. 27.78%), and fixation failure (5.56% vs. 22.22%, p < 0.05) were observed in the RA group.

Interpretation:

Combining manual reverse reduction with robotic assistance may improve surgical precision and maintain femoral neck anatomy, leading to better functional recovery and reduced complications.

Limitations:

• Retrospective design may introduce selection bias.
• Limited follow-up duration (24-36 months) may not capture long-term outcomes.

Conclusion:

The dual-optimization strategy may provide clinical benefits in managing geriatric valgus-impacted fractures.