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 . If complication didn’t occur, the patient can resume normal activities. The inverted triangle configuration is effective in reducing the rate of nonunion and implant failure . 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 pin, 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 can affect the mechanical strength of femoral neck fracture fixation .
By using the guide device, the fluoroscopy and operation time of the experimental group were shorter that of the conventional method. This is because in the experimental group, the three guide wires in the femoral neck can be inserted and observed at the same time with one fluoroscopy, while in the control group, each guide wire needs to be fluoroscopy separately. This present study demonstrated three advantage of the device. The first advantage is that the guide wires were accurately inserted in the femoral neck at one time in the experimental group. The hole spacing is 2mm in the device, so the position of the guide wires can be slightly adjusted to achieve the best position. The guide channels in the device are parallel. This ensures that the guide wire can be placed in a parallel inverted triangle configuration to the femoral neck. A second advantage is programmed surgical procedures. The surgeon’s experience was not important in the experimental group. When the reference guide wire is in the exact position, the guide wire passing through the guide channel must be parallel to the central axis of the femoral neck. The surgeon only needs to select the right channel to insert the three guide wires onto the lateral cortex of the femur in an inverted triangle configuration. The third advantage is that the femoral cortex was not drilled frequently in the experimental group. Drill attempts on the femoral cortex were no more than three times. So the device was easy to operate.
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 insertion . However, the operation was complicated. The navigation systems could improve accuracy [11,12,13], but the higher costs of the special instruments and increased radiation and operative time limited their clinical use .