“Free Hand” or Wire Guide: To the Editor

To the Editor:

We read with interest the article “Learning curve of internal fixation for nondisplaced femoral neck fractures: a cumulative sum analysis.”¹⁾ Stability of fracture depends upon the parallelity of the cancellous screws that fixes the fractured neck of femur. It is not easy to insert guidewire at the right position and in parallel orientation.²⁾ We all know from our experience that there is a learning curve involved in the passing of parallel screws, much more so if it is done “free hand.” Even a parallel wire guide requires passing of a central guide wire in exact central position. The paper does not mention if any wire guide was used during fixation.

We are curious to know about the cause of significant difference of operating time between the early and late experience group (52.2 ± 15.2 vs. 38.4 ± 13.0 minutes). Which part of the surgical procedure required more time in the early group and has learning improved the operating time in the late group?