A Comparative Study of Freehand Technique and A Novel Laser Guiding Navigation in Distal Locking of Femoral Intramedullary Nails

Abstract

Background Intramedullary nail(IMN) is one of the key essential minimally invasive "weapons" in orthopaedic trauma, while the distal locking is still challenging for surgeons. Although there are various inventions and technologies to improve the locking procedure, there are still problems such as inaccurate positioning, excessive radiation exposure, low first success rate and long learning curve. Therefore, a new laser guiding navigation device was designed and compared with the traditional freehand (FH) technique in the distal locking of femoral IMN. Methods The Self-designed laser navigation device (laser group) and freehand technique (FH group) were used in the distal locking of the IMNs in the patients with femoral diaphyseal fracture. All operations were performed by two surgeons of the same level. The differences between the two groups were compared in terms of radiation exposure time, operative time, first success rate, blood loss, visual analogue score(VAS), Harris score and healing time. Results 32 patients were enrolled and16 patients in each group. The results showed that the laser group was better than the FH group in terms of distal locking time (10(9/11)vs19.5(17.25/21)minutes, Z = 4.83, P < 0.001), distal locking radiation exposure time (46.5(41.25/51.75)vs105(88.25/140) seconds, Z = 4.807, P < 0.001), first success rate (30/32 vs 20/32, χ2 = 9.143, P = 0.002) and blood loss(60(50–100) vs 150(105-192.5) mL, Z = 3.610, P = 0.0003). There was no difference in Harris score, VAS score, or fracture healing time between the two groups. Conclusion Compared with the FH technique, the novel laser guiding navigation device for distal locking of femoral IMN has the advantages of shorter operative time, less radiation exposure and higher first success rate.

Comparison of freehand technique and a novel laser-guiding navigation system in femoral neck-cannulated screw fixation: a randomized controlled trial

“…After preoperative installation and debugging, the device can realize real-time calibration by the customized positioning ring, using G-arm. The accuracy and reliability of the device was verified in distal locking of femoral intramedullary nails [ 6 ]. Simultaneously, the freehand technique [ 25 ] is regarded as the gold standard, when the other methods do not work.…”

“…Numerous novel technologies, such as orthopedic surgical robot navigation, computer-aided navigation, and orthopedic minimally invasive intelligent visualization system, have been invented to optimize the process of channel screw placement [ 3 – 5 ]. However, including the most widely used freehand method, these technologies cannot satisfy the needs of simplicity, accuracy, and low radiation exposure simultaneously [ 6 ].…”