Background Femoral neck fractures have a high incidence rate. During treatment, closed reduction and minimally invasive screw placement are challenging due to limited space, which can easily lead to screw cut-out into the joint capsule, resulting in serious complications. Achieving accurate, minimally invasive, and closed screw placement is a significant clinical technical challenge.

Objective To compare the efficacy of remote interactive surgery with freehand percutaneous nailing for the treatment of femoral neck fractures.

Methods Clinical data about patients with femoral neck fracture admitted to the Department of Trauma Orthopaedics, Department of Orthopaedic Medicine, Chinese PLA General Hospital from January 2023 to June 2024 were retrospectively analyzed. According to the methods, patients were divided into tele-surgery group (treated by telesurgery) and freehand nailing group (freehand nailing). The operation time, intraoperative bleeding, number of intraoperative guide pin adjustments, number of intraoperative fluoroscopy, fracture healing time, Harris score of hip function and postoperative complications were compared between the two groups.

Results  A total of 30 patients were included, including 15 patients in the telesurgery group, 10 males and 5 females, aged (48.20±14.09) years old; 15 patients in the freehand nailing group, 9 males and 6 females, aged (47.33±16.44) years old, and the differences in age and gender between the two groups were not statistically significant (P > 0.05). The operation duration (1.70±0.24 h vs 2.19±0.63 h, P=0.008) and intraoperative haemorrhage (23.67±9.35 mL vs 55.00±36.29 mL, P=0.004) in the telesurgery group were lower than those in the freehand pinning group. The differences in the number of guide pin adjustments (1.93±0.88 vs 6.33±2.77) and the number of intraoperative fluoroscopies (5.13±1.35 vs 11.67±4.04) between the two groups were statistically significant (both P < 0.01). Both groups were followed up, and the postoperative fracture healing time in the telesurgery group was lower than that in the unarmed nailing group (17.00±2.33 weeks vs 25.00±2.85 weeks), and the Harris score was higher than that in the unarmed nailing group (82.73±6.31 vs 72.27±12.52), with statistically significant differences (both P < 0.01). In postoperative complications, 3 cases of partial screw cut-out were observed in the freehand screw placement group, resulting in mechanical instability at the fracture site and subsequent delayed union, whereas all screws remained in anatomical position in the robot-assisted surgical group.

Conclusion This system can provide good repositioning of the fracture end, shorten the operation time, reduce the number of intraoperative fluoroscopies, and have the advantage of Harris score of hip function in postoperative follow-up, which is an effective surgical procedure for the treatment of femoral neck fracture.