Precise placement of lag screws in operative treatment of trochanteric femoral fractures with a new guide system

Abstract Purpose We assessed the accuracy of a new guide system that we developed to place lag screws in the proper position with the minimum number of attempts for operative treatment of trochanteric femoral fractures. Methods A total of 55 consecutive trochanteric femoral fractures were treated with a cephalomedullary nail. The first 27 consecutive patients were treated with the standard operation (group A), while the new guide system was used in the last 28 consecutive patients (group B). The numbers of attempts to place K wires and the duration of surgery were noted. Accuracy of lag screw placement was evaluated by measuring the angle of deviation from the central axis of the femoral head. Results Deviation values ranged from −11̊ to +15̊ for the 27 cases in group A, with a median absolute deviation of 8̊ ± 6̊. That in the 28 cases after the introduction of the new guide system (group B) ranged from −5̊ to +6̊, with a median absolute deviation of 0.5̊ ± 3̊ ( P < 0.001). The total numbers of attempts to place lag screws and mean operation time decreased significantly after introduction of the new guide system ( P < 0.001). Conclusions With this new guide system, we are able to insert lag screws successfully in the optimal position even in most unstable fractures. The present study indicated that this new guide system and nail facilitate accurate placement of lag screws in the appropriate position with the minimum number of attempts.