Background: In this retrospective study, we examine the impact that employing a permanent derotation screw (DRS) has on the rate of revision for 2-hole dynamic hip screws (DHS, a.k.a. sliding hip screws), used for internal fixation of intracapsular neck of femur (NOF) fractures. To the best of our knowledge, we are the first to examine the impact of using a derotation screw on DHS revision rate. Methods: We obtained a list of 64 patients suffering intracapsular NOF fracture treated with 2-hole DHS over a 5-year period, 28 of these were also treated with a DRS, forming our DRS group, 36 were not (non-DRS group). Fracture severity and patient demographics between the groups were compared to ensure homogeneity. The rate of revision to arthroplasty (total or hemi) of the two groups were compared. Results: The mean age in the DRS group was 70.79 years, 1.77 years lower than the non-DRS group (p=0.570). The DRS group had a rate of revision of 14%, in comparison with 39% in the non-DRS group (p=0.0299), corresponding with a number needed to treat of 4.06 derotation screws to prevent a single failure. Conclusions: In this study, employing a permanent derotation screw alongside a 2-hole DHS was associated with a significantly lower rate of revision to arthroplasty than using a 2-hole DHS alone. We would recommend this be further investigated with prospective randomized trials, to provide robust evidence and make clinical recommendations.