FNS - Food and Nutrition Administration (formerly Food and Nutrition Service)

Note: As of June 1, 2026, the Food and Nutrition Service (FNS) was officially renamed the Food and Nutrition Administration (FNA) under the USDA.

What it is

• A federal agency within the U.S. Department of Agriculture (USDA)
• Headquartered in Alexandria, Virginia
• Mission: Provide nutrition assistance to low-income individuals and families and promote healthy eating across America

Key Programs Administered

Key Facts

• Serves tens of millions of Americans annually
• Works through state agencies that administer programs under federal standards
• Budget is one of the largest within USDA
• Focused on reducing fraud, waste, and abuse in nutrition programs

DHS - Department of Homeland Security

What it is

• A cabinet-level federal department of the U.S. government
• Created in 2002 after the September 11 attacks (via the Homeland Security Act of 2002)
• One of the largest federal departments with 260,000+ employees
• Current Secretary (as of 2025-2026): Kristi Noem

Core Missions

1. Preventing terrorism and enhancing security
2. Border security and immigration enforcement
3. Disaster preparedness and response
4. Cybersecurity
5. Critical infrastructure protection

Major Component Agencies

Key 2025-2026 Highlights

• Strong focus on border enforcement and increased ICE detention capacity (50,000 beds)
• Expanded counter-drone (C-UAS) technology deployment
• Annual Homeland Threat Assessment identifies domestic/foreign terrorism as high threats
• Partnership with international allies on biosecurity and border threats

Dynamic Hip Screw (DHS)

Design and Mechanism

• A large-diameter lag screw inserted into the femoral head along the neck
• A barrel on the side plate into which the lag screw can freely slide
• 4-hole (or more) side plate fixed to the lateral femoral cortex with cortical screws

Indications

• Stable extracapsular (intertrochanteric) fractures - primary indication; provides reliable head-shaft connection
• Unstable extracapsular fractures - can be used but intramedullary nail may be preferred
• Intracapsular fractures in physiologically young patients (to preserve native femoral head)
• Undisplaced intracapsular fractures where head preservation is the goal

Surgical Technique Highlights

• Open or percutaneous approach to lateral femur
• Guidewire placed under fluoroscopy into the center of the femoral head (tip-apex distance <25 mm is key)
• Sequential reaming then screw insertion
• Side plate attached with cortical screws
• Tap recommended in non-osteoporotic bone; consider derotational screw to prevent rotational instability

Limitations

• Larger implant, more tissue dissection
• Rotational instability of the femoral head around the lag screw axis (only one point of fixation in the head)
• Not ideal for high Pauwels angle fractures (vertical shear - risk of implant failure)
• More blood loss and longer operative time compared to FNS

Femoral Neck System (FNS)

Design and Mechanism

• A large femoral neck bolt (main axial load-bearing element)
• An antirotation screw (ARScrew) locked to the bolt at a fixed angle - prevents rotation of the femoral head fragment
• A low-profile base plate fixed to the lateral femur

Indications

• All types of femoral neck fractures - both displaced and undisplaced
• Particularly suited for intracapsular fractures in younger patients (head preservation)
• High Pauwels angle (type III) fractures where rotational stability is most important
• Cases where minimally invasive approach is desired

Advantages Over Cannulated Screws and DHS

"Data suggest decreased rates of avascular necrosis (AVN), complications, shortening, fluoroscopy use, and increased functional outcomes compared with cannulated screws. A biomechanical study has shown the stability of the FNS to be similar to the dynamic hip screw and superior to multiple cannulated screws."

Head-to-Head Comparison: FNS vs DHS

Recent Evidence (2024-2025)

• FNS had shorter operative time, less blood loss, and better Harris Hip Score
• No significant difference in complication rates, femoral neck shortening, or hospitalisation
• FNS can "optimise surgical procedures" but overall complication rates are comparable

• FNS: operative time ~20 minutes shorter (95% CI: -26 to -13 min, p<0.001)
• FNS: blood loss ~17 mL less (p<0.001)
• FNS: Harris Hip Score significantly better (p=0.02)
• No difference in femoral neck shortening, nonunion, or osteonecrosis of femoral head
• Conclusion: FNS is a viable alternative to DHS for femoral neck fractures

Summary: When to Choose Which?

• Campbell's Operative Orthopaedics, 15th Ed 2026
• Bailey and Love's Short Practice of Surgery, 28th Ed
• Jiang et al., JPMA 2024 [PMID 38419236]
• Lim et al., Medicine 2025 [PMID 41366897]