Biomechanical evaluation of compression buttress screw and medial plate fixation for the treatment of vertical femoral neck fractures

•A novel fixation strategy, compression buttress screw (CBS) fixation, was proposed for femoral neck fractures. Two differently-designed screws (PTCS and FTHCS) combined to construct a regular triangle configuration play distinct roles in biomechanics. One PTCS in the proximal neck functions as a sliding implant to provide dynamic compression during surgery, while two FTHCSs in the distal neck play the role of asymptotical sliding and as an “interosseous buttress” in the medial quadrant of the femoral neck postoperatively.•Biomechanical testing revealed that the CBS fixation was comparable to the anteromedial plate fixation (AMP) and medial buttress plate fixation (MBP), and demonstrated superior biomechanical performance than medial buttress plate fixation without proximal screw (MBPw) to some extent.•Compared with the plate fixations, the CBS fixation could not only achieve similar biomechanical strength but also possesses the surgical advantages of pure screw fixation. Thus, it is advisable to promote the application of CBS fixation for vertical femoral neck fracture.