{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:13:25Z","timestamp":1783660405353,"version":"3.55.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>\n                    Achieving anatomical restoration in valgus-impacted femoral neck fractures remains a clinical challenge, particularly in the elderly. This retrospective study evaluated a \u201cdual-optimization\u201d strategy\u2014integrating manual reverse closed reduction with robotic-assisted internal fixation\u2014compared to conventional\n                    <jats:italic>in-situ<\/jats:italic>\n                    freehand fixation. Seventy-two patients were divided into the reduction-assisted (RA,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200936) and\n                    <jats:italic>in-situ<\/jats:italic>\n                    freehand (IF,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200936) groups. While the RA group required longer operative times (1.74\u2009\u00b1\u20090.63\u2005h vs. 1.29\u2009\u00b1\u20090.37\u2005h,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&amp;lt;\u20090.05), it demonstrated superior technical precision with significantly fewer fluoroscopy sessions (33.28\u2009\u00b1\u20097.71 vs. 56.56\u2009\u00b1\u200919.71) and guide-pin adjustments (0.17\u2009\u00b1\u20090.38 vs. 1.89\u2009\u00b1\u20091.09,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&amp;lt;\u20090.0001). Radiologically, the RA group achieved effective deformity correction (valgus and posterior tilt angles,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&amp;lt;\u20090.0001) and exhibited higher screw placement accuracy (5.92\u2009\u00b1\u20093.75\u00b0 vs. 11.14\u2009\u00b1\u20095.28\u00b0) and superior screw dispersion (22.10\u2009\u00b1\u20091.47% vs. 18.83\u2009\u00b1\u20091.22%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&amp;lt;\u20090.05). At 24\u201336 months follow-up, the RA group showed significantly less femoral neck shortening (2.5\u2009\u00b1\u20092.1\u2005mm vs. 9.1\u2009\u00b1\u20093.8\u2005mm,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&amp;lt;\u20090.0001) and higher Harris Hip Scores (82.00\u2009\u00b1\u200911.44 vs. 73.61\u2009\u00b1\u200915.07,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&amp;lt;\u20090.05). Furthermore, the RA group had markedly 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%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&amp;lt;\u20090.05). In conclusion, within the limitations of this cohort, combining manual reverse reduction with robotic assistance synergistically may provide clinical benefits by improving surgical precision and maintaining femoral neck anatomy, showing a positive tendency toward better functional recovery and reduced complications for geriatric valgus-impacted fractures.\n                  <\/jats:p>","DOI":"10.3389\/fsurg.2026.1830958","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:24:14Z","timestamp":1783657454000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical efficacy of manual reverse closed reduction and robot-assisted cannulated screw fixation for valgus-impacted osteoporotic femoral neck fractures in the elderly: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuxiang","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Sports Injury and Arthroscopy, Tianjin Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Sports Injury and Arthroscopy, Tianjin Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Tianjin Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhipeng","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Tianjin Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Tianjin Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinguang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Tianjin Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1002\/jbmr.4821","article-title":"Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality","volume":"38","author":"Sing","year":"2023","journal-title":"J Bone Miner Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"105832","DOI":"10.1016\/j.archger.2025.105832","article-title":"Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: a systematic analysis of the global burden of disease study 2021","volume":"133","author":"Tian","year":"2025","journal-title":"Arch Gerontol Geriatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1016\/j.injury.2022.12.008","article-title":"Mortality following hip fracture: trends and geographical variations over the last SIXTY years","volume":"54","author":"Haleem","year":"2022","journal-title":"Injury"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1007\/s00198-011-1601-6","article-title":"Secular trends in the incidence of hip and other osteoporotic fractures","volume":"22","author":"Cooper","year":"2011","journal-title":"Osteoporos Int"},{"key":"B5","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1186\/s13018-021-02622-z","article-title":"Osteosynthesis of non-displaced femoral neck fractures in the elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes","volume":"16","author":"Vazquez","year":"2021","journal-title":"J Orthop Surg Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.injury.2020.10.028","article-title":"Comparison of femoral neck shortening and outcomes between in situ fixation and fixation after reduction for severe valgus-impacted femoral neck fractures","volume":"52","author":"Park","year":"2020","journal-title":"Injury"},{"key":"B7","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1111\/os.13582","article-title":"In-out-in\u201d percutaneous reduction technique for treatment of Valgus-impacted femoral neck fractures: a technical trick and case series","volume":"15","author":"Yu","year":"2022","journal-title":"Orthop Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e44679","DOI":"10.1097\/MD.0000000000044679","article-title":"Predicting surgical outcomes of non-displaced or valgus-impacted femoral neck fractures: a novel preoperative CT-based comprehensive assessment method","volume":"104","author":"Jia","year":"2025","journal-title":"Medicine (Baltimore)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"259","DOI":"10.5371\/hp.2023.35.4.259","article-title":"Postoperative Valgus deformity and progression of ostheoarthritis in non-displaced femoral neck fractures","volume":"35","author":"Kim","year":"2023","journal-title":"Hip & Pelvis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"40","DOI":"10.3390\/medicina61010040","article-title":"Improving outcomes with sequential fixation using long-threaded screws for Valgus-impacted femoral neck fractures","volume":"61","author":"Koh","year":"2024","journal-title":"Medicina (B Aires)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"178","DOI":"10.5371\/hp.2025.37.3.178","article-title":"Outcomes of reduction and fixation versus in-situ fixation for Valgus-impacted femoral neck fractures: a systematic review","volume":"37","author":"Heu","year":"2025","journal-title":"Hip & Pelvis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1177\/11207000231210240","article-title":"Valgus-impacted subcapital neck of femur fractures: a systematic review, meta-analysis with cost analysis of fixation in-situ versus nonoperative management","volume":"34","author":"Vidakovic","year":"2023","journal-title":"Hip Int"},{"key":"B13","doi-asserted-by":"publisher","first-page":"295","DOI":"10.18999\/nagjms.87.2.295","article-title":"Comparative outcomes of in-situ fixation and fixation after reduction in geriatric patients with severe valgus-impacted femoral neck fractures: a retrospective multicenter (TRON group) study","volume":"87","author":"Nobori","year":"2025","journal-title":"Nagoya J Med Sci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1080\/10255842.2022.2092727","article-title":"Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture","volume":"26","author":"Dai","year":"2020","journal-title":"Comput Methods Biomech Biomed Engin"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-18891\/v1","article-title":"Reverse fracture displacement direction closed reduction technique (RCRT) for the treatment of valgus impacted femoral neck fracture","author":"Zhu","year":"2020","journal-title":"Res Sq"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2472","DOI":"10.1111\/os.12994","article-title":"Accurate placement of cannulated screws in femoral neck fractures: screw and guide wire combined technique","volume":"13","author":"Chen","year":"2021","journal-title":"Orthop Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1111\/os.12548","article-title":"Treatment of femoral neck fractures with cannulated screw invasive internal fixation assisted by orthopaedic surgery robot positioning system","volume":"11","author":"Wang","year":"2019","journal-title":"Orthop Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e25926","DOI":"10.1097\/MD.0000000000025926","article-title":"Robot-assisted vs freehand cannulated screw placement in femoral neck fractures surgery","volume":"100","author":"Zheng","year":"2021","journal-title":"Medicine (Baltimore)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1186\/s12891-024-07325-0","article-title":"Comparison of rehabilitation outcomes between robot-assisted and freehand screw placement in treatment of femoral neck fractures: a systematic review and meta-analysis","volume":"25","author":"Li","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e24164","DOI":"10.2196\/24164","article-title":"Application of robot positioning for cannulated screw internal fixation in the treatment of femoral neck fracture: retrospective study","volume":"9","author":"Wan","year":"2020","journal-title":"JMIR Med Inform"},{"key":"B21","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1002\/acr.24231","article-title":"Measures of hip function and symptoms","volume":"72","author":"Weick","year":"2020","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.otsr.2009.11.012","article-title":"Garden I femoral neck fractures in patients 65 years old and older: is conservative functional treatment a viable option?","volume":"96","author":"Buord","year":"2010","journal-title":"Orthop Traumatol Surg Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"303","DOI":"10.3109\/17453670902967281","article-title":"A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year","volume":"80","author":"Henrik","year":"2009","journal-title":"Acta Orthop"},{"key":"B24","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1097\/01.ta.0000241143.71274.63","article-title":"Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function","volume":"64","author":"Michael","year":"2008","journal-title":"J Trauma"},{"key":"B25","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1302\/0301-620X.73B6.1955443","article-title":"Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases","volume":"73","author":"E L","year":"1991","journal-title":"J Bone Joint Surg Br"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2743","DOI":"10.1016\/j.injury.2016.10.022","article-title":"Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years","volume":"47","author":"Song","year":"2016","journal-title":"Injury"},{"key":"B27","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1186\/s12891-023-06874-0","article-title":"The association between three-dimensional measurement of posterior tilt angle in impacted femoral neck fractures and osteonecrosis of the femoral head","volume":"24","author":"Cong","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"B28","doi-asserted-by":"publisher","first-page":"3453","DOI":"10.1016\/j.injury.2021.08.002","article-title":"Incidence and risk factors for failure of conservative treatment for valgus impacted femoral neck fractures in elderly patients with high-risk comorbidities-A bi-center retrospective observational study","volume":"52","author":"Shin","year":"2021","journal-title":"Injury"},{"key":"B29","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1016\/j.otsr.2019.03.016","article-title":"Three-dimensional analyses to predict surgical outcomes in non-displaced or valgus impaction fractures of the femoral neck: a multicenter retrospective study","volume":"105","author":"Shin","year":"2019","journal-title":"OTSR"},{"key":"B30","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1186\/s12891-025-08393-6","article-title":"Risk factors of neck re-shortening after reduction and fixation in patients with valgus-impacted femoral neck fractures","volume":"26","author":"Hou","year":"2025","journal-title":"BMC Musculoskelet Disord"},{"key":"B31","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/s12891-024-07180-z","article-title":"The significance of reduction of valgus-intercalated femoral neck fracture with valgus angle\u2009>\u200915\u00b0and the selection of internal fixation by finite element analysis","volume":"25","author":"Yusufu","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"B32","doi-asserted-by":"publisher","first-page":"763","DOI":"10.4055\/cios25125","article-title":"The application of a noninvasive extracapsular traction reduction technique in Valgus-impacted femoral neck fracture: radiological and clinical results","volume":"17","author":"Ouyang","year":"2025","journal-title":"Clin Orthop Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"103777","DOI":"10.1016\/j.eats.2025.103777","article-title":"Arthroscopy-assisted reduction and fixation of Valgus-impacted femoral neck fractures with joystick technique","volume":"14","author":"Li","year":"2025","journal-title":"Arthrosc Tech"},{"key":"B34","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1186\/s12891-023-06551-2","article-title":"Nonanatomical reduction of femoral neck fractures in young patients treated with femoral neck system: a retrospective cohort study","volume":"24","author":"Jiang","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"B35","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1186\/s13018-021-02580-6","article-title":"Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality","volume":"16","author":"Zhao","year":"2021","journal-title":"J Orthop Surg Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"625","DOI":"10.3928\/01477447-20151002-05","article-title":"Optimizing stability in femoral neck fracture fixation","volume":"38","author":"Ye","year":"2015","journal-title":"Orthopedics"},{"key":"B37","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1007\/s11914-019-00535-9","article-title":"Biomechanics of osteoporotic fracture fixation","volume":"17","author":"Marianne","year":"2019","journal-title":"Curr Osteoporos Rep"},{"key":"B38","doi-asserted-by":"publisher","first-page":"3906","DOI":"10.3760\/cma.j.issn.0366-6999.2011.23.014","article-title":"Computer-assisted navigation systems for insertion of cannulated screws in femoral neck fractures: a comparison of bi-planar robot navigation with optoelectronic navigation in a Synbone hip model trial","volume":"124","author":"Jun-qiang","year":"2012","journal-title":"Chin Med J (Engl)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1097\/00005131-199506000-00006","article-title":"Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method","volume":"9","author":"Lindequist","year":"1995","journal-title":"J Orthop Trauma"},{"key":"B40","first-page":"692","article-title":"Fixation with percutaneous cannulated screws assisted by robot navigation for femoral neck fractures","volume":"17","author":"Liu","year":"2015","journal-title":"Chinese Journal of Orthopaedic Trauma"},{"key":"B41","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1111\/os.12451","article-title":"Guidance for the treatment of femoral neck fracture with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system","volume":"11","author":"Wu","year":"2019","journal-title":"Orthop Surg"},{"key":"B42","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1186\/s13018-023-04070-3","article-title":"Robotic-assisted systems for the safe and reliable treatment of femoral neck fractures: retrospective cohort study","volume":"18","author":"Wang","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"B43","doi-asserted-by":"publisher","first-page":"5072","DOI":"10.3390\/jcm13175072","article-title":"Comparative efficacy and safety of robot-assisted vs. Freehand screw placement in femoral neck fractures: an updated systematic review and meta-analysis","volume":"13","author":"Mert","year":"2024","journal-title":"J Clin Med"},{"key":"B44","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1007\/s11701-025-02695-6","article-title":"Advantages of TiRobot-assisted technology in internal fixation of femoral neck fractures: a meta-analysis of surgical parameters and complications","volume":"19","author":"Dai","year":"2025","journal-title":"J Robot Surg"},{"key":"B45","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1111\/os.12915","article-title":"Tirobot-assisted percutaneous cannulated screw fixation in the treatment of femoral neck fractures: a Minimum 2-year follow-up of 50 patients","volume":"13","author":"Zhu","year":"2021","journal-title":"Orthop Surg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1830958\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:24:16Z","timestamp":1783657456000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1830958\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":45,"alternative-id":["10.3389\/fsurg.2026.1830958"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1830958","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]},"article-number":"1830958"}}