The goal of this clinical trial is to compare two different methods of screw path planning-AI-assisted versus surgeon-directed-in freehand percutaneous femoral neck fracture fixation surgery. The study will include adult patients diagnosed with femoral neck fractures who are eligible for cannulated screw fixation under fluoroscopic guidance.The main questions it aims to answer are:
Does AI-assisted screw path planning improve the radiographic accuracy of screw placement (screw deviation, tip position, and inter-screw parallelism)? Does AI-assisted planning reduce operative time, number of intraoperative fluoroscopy exposures, intraoperative blood loss (mL) and surgeon workload compared with surgeon-directed planning? Does AI-assisted planning reduce postoperative complications and improve functional outcomes compared to surgeon-directed planning? Researchers will compare the AI-assisted planning group to the surgeon-directed planning group to determine whether AI guidance contributes to enhanced surgical precision, reduced intraoperative burden, and improved recovery outcomes.
Participants will:
Undergo freehand percutaneous internal fixation of femoral neck fractures with either AI-assisted or surgeon-directed screw path planning, Receive standardized perioperative care and follow-up at defined intervals, Be evaluated through clinical assessments, imaging studies, and documentation of intraoperative and postoperative metrics over a 12-month follow-up period.
Age ≥ 18 years;
Radiologically confirmed diagnosis of femoral neck fracture (displaced or non-displaced);
Scheduled to undergo internal fixation with cannulated screws as the initial treatment strategy during the study period;
Capable of understanding the study procedures and providing informed consent;
Evidence of avascular necrosis of the femoral head on the affected side prior to surgery;
Inability to tolerate the surgical intervention;
Severe physical illnesses, cognitive problems (such as memory loss), or mental health conditions that may impair the ability to comply with medical instructions or attending scheduled follow-up appointments.
Parallel
AI-Assisted Screw Path Planning
Procedure/SurgeryThe trajectory for screw placement during femoral neck fracture fixation will be guided by an AI algorithm based on intraoperative X-ray imaging. The system will automatically suggest the screw entry point and trajectory, which are displayed for the surgeon to follow during freehand guidewire insertion under fluoroscopy. The surgeon will proceed with the operation after confirming the feasibility of the AI-generated plan. In principle, surgeons are advised not to modify the AI-recommended trajectory unless necessary, to preserve the independent evaluative value of the AI-assisted plan. If significant disagreement arises between the surgeon's judgment and the AI-recommended trajectory, a third-party orthopedic specialist-blinded to group allocation-will conduct an independent postoperative assessment of the screw placement's appropriateness and accuracy.
Surgeon-Directed Screw Path Planning
Procedure/SurgeryThe screw trajectory will be entirely determined manually by the operating surgeon, based on personal experience and interpretation of intraoperative fluoroscopy, without reliance on any AI recommendation module.
Radiographic Accuracy of Screw Placement
Accuracy of screw placement assessed on standardized anteroposterior and lateral radiographs.
Number of Fluoroscopy Exposures
Total number of C-arm fluoroscopy shots used during screw placement will be recorded and compared between groups.
Operative Time
Total surgical time will be recorded and compared between the AI-assisted and surgeon-directed groups.
Intraoperative Blood Loss (mL)
Blood loss will be estimated intraoperatively and documented for each case.
Number of Drilling Attempts
Total number of drilling attempts required to achieve acceptable guidewire placement.
Surgeon Confidence Score
Surgeon self-reported confidence in the trajectory planning and screw placement accuracy measured using a 5-point Likert scale.
AI Override / Modification Rate (AI Group Only)
Frequency and proportion of cases where the operating surgeon significantly modified or overrode the AI-recommended trajectory, with reasons recorded.
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