Closed reduction and internal fixation have become the standard methods for the treatment of femoral neck fractures in patients 60 years of age or younger. Fixation with three parallel cannulated screws placed in an inverted triangle configuration, is a common method for femoral neck fracture 7. If complication didn’t occur, the patient can resume normal activities. The inverted triangle is effective in reducing the rate of nonunion and implant failure 8. However, accurate guide wire placement necessitates high requirement for the surgeon and requires more fluoroscopic and operative time. So, we developed this device to make it easier.
The conventional method of screw placement for femoral neck fractures is mainly performed by surgeons with experience under ﬂuoroscopic monitoring. During the screw fixation of femoral neck fracture with closed reduction, the femoral neck was not exposed and the desired position was not easily obtained due to the lack of necessary reference during the placement of the first guide needle, which often requires multiple drilling for success. Multiple drilling not only resulted in prolonged operation time, increased tissue damage, and increased doctor-patient exposure time to the X-ray radiation, but also resulted in unstable fracture fixation due to more or less osteoporosis in the femoral neck of most patients9.
By using the guide device, the fluoroscopy and operation time of the experimental group were shorter that of the conventional method. The most important thing is to successfully insert the guide wires in the femoral neck at one time. The femoral cortex was not drilled frequently.
The guide device is easy to operate. It works like inserting the spiral blade in the proximal femoral nail anti-rotation system. When the device is sutured on the lateral side of the thigh between the anterior and posterior femur cortex, three Kirschner wire were inserted onto the cortex of femur. Anteroposterior and lateral fluoroscopic images were acquired. The trajectory of the Kirschner wire in the femoral neck was judged according to the extension of image of Kirschner wire on the c-arm fluoroscope. The collodiaphyseal angle can be adjusted by opening or closing of damping. The angle of anteversion can be adjusted by rotating the rod in steel buckle. Once the Kirschner wires were in right place, they were drilled into the femoral neck.
Other researchers have developed guides to accurately place Kirschner wires. Yin et al. demonstrated a novel guidewire aiming device to improve the accuracy of guidewire lnsertion10. However, the operation was complicated. The navigation systems could improve accuracy11,12,13 but the higher costs of the special instruments and increased radiation and operative time limited their clinical use14.