Comparison of free-hand fluoroscopic guidance and electromagnetic navigation in distal locking of tibia intramedullary nails

Abstract

BackgroundIt is challenges for surgeon to position the distal locking screw of a tibia intramedullary nail. The traditional free-hand (FH) technique is related to the proficiency of surgeons and has a long learning curve. Furthermore, the radiation dose and the accuracy of screw placement should be taken into account. The new technology, the electromagnetic navigation system (ET), which is a radiation-free way to locate the position of the drill bit. The purpose of our study is to evaluate the results of the ET for distal locking screw of a tibia intramedullary nail and to compare the effects with the FH technique.MethodsEighty-nine cases of tibia diaphyseal fracture who needed to treat by intramedullary nails were analyzed retrospectively, and were divided into 2 groups. Patients in navigation group (n = 54) were treated with intramedullary nail using the ET for distal locking, while other 35 patients using FH technique. Intraoperative fluoroscopy exposure times, screw insertion times, and healing times were recorded. The parameter was used for comparison in 2 groups.ResultsThe mean time of distal locking in the ET technique was significant less than that in the FH group (5.89 ± 2.02 minutes vs 12.26 ± 4.40 minutes) and the exposure time was reduced in ET group significantly (2.13 ± 0.73 seconds vs 19.09 ± 10.41 seconds). The healing time was proved to be coincident in FH group and ET group (15.34 ± 2.98w vs 16.06 ± 3.74w). The one-time success rate of distal locking nail operation was 100% in the navigation group, which was significantly higher than that in FH group (P < .05).ConclusionCompared with the FH technique, the ET for distal locking of tibia intramedullary nail has the advantages of high efficiency and short locking time without radiation.

Imaging in Fracture surgeries - a tool for quality assessment

“…In our study, operating surgeon decision is the main say to ask for sequential imaging at different steps of nailing from the entry of guide wire, fracture reduction, serial reaming of the canal, nail measurement, intramedullary nail insertion (reamed/unreamed) (Court-Brown et al, 1996;Leroux et al, 2015) two proximal and two distal locking screws done with the jig and free hand technique (Wang et al, 2018;Whatling and Nokes, 2006), intramedullary ixation with two proximal and two distal locking screws for tibia and femur shaft fractures only were considered with inbuilt static and dynamic options.…”

Three-dimensional computer-assisted corrective osteotomy with a patient-specific surgical guide for an antebrachial limb deformity in two dogs

“…Furthermore, as extensively demonstrated in human medicine (REF computer assisted vs freehand), computer assisted-surgeries could be more accurate and faster than free-hand techniques when performing osteotomy 13 fracture fixation 17 , joint replacement surgery 11 and vertebral screw placement as well 5 .…”

A New Accurate, Simple and Less Radiation Exposure Device for Distal Locking of Femoral Intramedullary Nails

“…effectiveness and safety of the laser device with freehand technique. 7,25 According to literature, the freehand positioning of the distal locking screw takes about 7-15 minutes 10 . It takes more operative and radiation exposure time for novice surgeons.…”

“…However, these technologies (including traditional freehand technique 7 ) still have some limitations, such as inaccurate positioning, low first success rate, high demand for expensive equipment, long learning curve of surgeons. [6][7][8][9][10][11][12][13] Based on the above problems, our team designed a laser guiding navigation device based on G-arm and a matching positioning technique by taking advantage of the characteristics of the accuracy and stability of laser. The device has the advantages of easy installation, accurate positioning, no radiation exposure during operation, and is easy to master.…”