A Mechanical Distal Aiming Device for Distal Locking in Femoral Nails

Krettek, Christian; Könemann, B.; Miclau, Theodore; Kölbli, R.; Machreich, T.; Tscherne, H.

doi:10.1097/00003086-199907000-00033

Cited by 47 publications

(18 citation statements)

References 20 publications

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“…Many devices have been developed for distal locking [12]. Examples include proximally mounted targeting devices, stereo fluoroscopy, mechanical guides, and optical and electromagnetic navigation systems that help locate the center of the distal locking nail holes.…”

Section: Distal Locking In Intramedullary Nailingmentioning

confidence: 99%

Bone-mounted miniature robot for surgical procedures: concept and clinical applications

Shoham

Burman²,

Zehavi³

et al. 2003

IEEE Trans. Robot. Automat.

270

135

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Abstract-This paper presents a new approach to robot-assisted spine and trauma surgery in which a miniature robot is directly mounted on the patient's bony structure near the surgical site. The robot is designed to operate in a semiactive mode to precisely position and orient a drill or a needle in various surgical procedures. Since the robot forms a single rigid body with the anatomy, there is no need for immobilization or motion tracking, which greatly enhances and simplifies the robot's registration to the target anatomy. To demonstrate this concept, we developed the MiniAture Robot for Surgical procedures (MARS), a cylindrical 5 7 cm 3 , 200-g, six-degree-of-freedom parallel manipulator. We are currently developing two clinical applications to demonstrate the concept: 1) surgical tools guiding for spinal pedicle screws placement; and 2) drill guiding for distal locking screws in intramedullary nailing. In both cases, a tool guide attached to the robot is positioned at a planned location with a few intraoperative fluoroscopic X-ray images. Preliminary in-vitro experiments demonstrate the feasibility of this concept.

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Section: Distal Locking In Intramedullary Nailingmentioning

confidence: 99%

Bone-mounted miniature robot for surgical procedures: concept and clinical applications

Shoham

Burman²,

Zehavi³

et al. 2003

IEEE Trans. Robot. Automat.

270

135

View full text Add to dashboard Cite

show abstract

“…However, operating room personnel within 12 inches of the fluoroscopy beam (such as when performing the free hand technique for interlocking screw insertion using a radiolucent drill) receive significant amounts of radiation exposure, particularly to the unprotected eyes, neck, and hands [8]. Radiation exposure should be decreased when possible [6]. The purpose of this study was to compare prospectively the duration of the nailing procedure, number of radiation exposures or images required for distal locking, and the accuracy of interlocking screw placement with the nail over nail technique versus using the free hand technique for femoral intramedullary nails.…”

Section: Introductionmentioning

confidence: 99%

Nail over nail technique for distal locking of femoral intramedullary nails

Rohilla

Singh

Magu

et al. 2008

International Orthopaedics (SICOT)

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The free hand technique remains the most popular method for distal locking; however, radiation exposure is a major concern. In an endeavour to overcome this concern, distal locking with the nail over nail technique is evaluated. Seventy patients with femoral diaphyseal fractures treated by intramedullary nailing were divided in two groups for distal locking: either using the free hand technique (group I) or with the nail over nail technique (group II). The average number of images taken to achieve nail insertion without locking, for distal locking, and for the complete procedure in group I was 25.8, 24.2, and 50.08, respectively, compared with 24.8, 4.1, and 28.9, respectively, in group II (statistically extremely significant decrease in radiation). The nail over nail technique appears to be a reliable solution for decreasing radiation exposure during closed femoral intramedullary nailing. However, over-reaming of 1.5 mm is the key to the success of the technique.

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“…These techniques include laser [5] or computer guidance [12] and the use of long proximally mounted targeting devices [10,11,13,15]. The Surgical Implant Generation Network (SIGN) (Richland, WA, USA) nail has a proven record of success in treating femoral shaft fractures without intraoperative fluoroscopy [15].…”

Section: Introductionmentioning

confidence: 99%

Surgical Technique: Static Intramedullary Nailing of the Femur and Tibia Without Intraoperative Fluoroscopy

White

Sorkin

Konopka

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background On a recent mission directed at definitive care for victims of the Haitian earthquake, the orthopaedic team developed a technique for freehand distal locking of femoral and tibial nails without intraoperative fluoroscopy or proximally mounted targeting jigs. Description of TechniqueAfter performing open antegrade or retrograde nailing by standard techniques, the freehand lock must be obtained before doing standard outrigger locking. This allows the surgeon to control the nail and deliver the locking hole in the nail to a unicortical drill hole in the femur. Before nail insertion, the distance of the desired locking hole is measured from the outrigger in a standard way such that it can be reproduced after the nail is inserted. Through a unicortical drill hole, the nail is palpated with the tip of a Kirschner wire and systematic maneuvers allow the Kirschner wire to palpate and fall into the locking hole. The Kirschner wire is tapped across the second cortex before drilling. The screw is inserted, and the ball-tipped insertion guidewire is placed back into the nail to palpate the crossing screw confirming position. Patients and Methods We treated 16 patients with 18 long bone fractures using the described technique. We assessed patients clinically and radiographically immediately postoperatively. Results A total of 19 blind freehand interlocks were attempted, and 17 were successful as assessed by direct intraoperative observations and by postoperative radiographs. Conclusions We describe a simple technique for performing static locked intramedullary nailing of the femur and tibia without fluoroscopy. This technique was successful in most cases and is intended for use with any nailing system only when fluoroscopy or specialized systems for nailing without fluoroscopy are not available.

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A Mechanical Distal Aiming Device for Distal Locking in Femoral Nails

Cited by 47 publications

References 20 publications

Bone-mounted miniature robot for surgical procedures: concept and clinical applications

Bone-mounted miniature robot for surgical procedures: concept and clinical applications

Nail over nail technique for distal locking of femoral intramedullary nails

Surgical Technique: Static Intramedullary Nailing of the Femur and Tibia Without Intraoperative Fluoroscopy

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