Free-hand distal locking of intramedullary nails: How to quickly achieve perfect circles without specific instrumentation

Rodriguez, Thibaud; Laborde, Alexandre; Khédira, Tarek; Ledoux, Didier; Hamitouche, Kamel

doi:10.1016/j.otsr.2021.102831

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…It seems that trauma-trained surgeons took care of the more complex fracture patterns and more frequently opted for lateral patient position. Preparation times were comparable between the two 1–17 approaches, and lateral positioned cases were completed more quickly on average. More of the obese BMI patients were treated in the lateral position, which may be beneficial in this population at risk of longer intraoperative times and slower recovery times.…”

Section: Discussionmentioning

confidence: 88%

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Technical Trick: Traction Table Assisted Lateral Decubitus Patient Positioning in Cephalomedullary Nailing of Geriatric Intertrochanteric Femur Fractures.

Peters V,

Harris,

Rinehart

et al. 2023

Journal of Orthopaedic Trauma

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Summary: Cephalomedullary nail fixation of geriatric intertrochanteric femur fractures is, and will continue to be, performed by most orthopaedic surgeons. The influence of technical factors on outcome is clear, and it is imperative that orthopaedic surgeons use contemporary strategies to achieve adequate reduction and fixation. The lateral patient position on a traction table potentially confers several advantages which surgeons can use to achieve quality outcomes even in patients who have challenging body morphology and/or fracture anatomy. A preferred surgical technique for lateral positioning is presented here and a case series comparing supine versus lateral nailing procedures. Lateral positioning was used more frequently in obese patients and by trauma-trained surgeons, and the results equal or exceed those in supine cases with respect to reduction and placement of fixation. Training surgeons in lateral nailing can deliver a reproducible strategy for reduction and fixation in straightforward and complex cases. By mastering the setup and technique on more simple cases, surgeons can be better prepared for the more complex where advantages of lateral nailing are even more apparent.

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Section: Discussionmentioning

confidence: 88%

“…In cases of long cephalomedullary nail fixation, distal freehand interlocking is performed with "perfect circles" technique. 1 Incisions are irrigated, closed, and dressed according to preference. The patient is removed from the table in the reverse sequence as compared setup.…”

Section: Surgical Techniquementioning

confidence: 99%

Technical Trick: Traction Table Assisted Lateral Decubitus Patient Positioning in Cephalomedullary Nailing of Geriatric Intertrochanteric Femur Fractures.

Peters V,

Harris,

Rinehart

et al. 2023

Journal of Orthopaedic Trauma

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“…Intramedullary nailing is one of the current standard treatments for long bone diaphyseal fractures [1][2][3] , however, positioning the distal locking screw is one of the greatest challenges [4][5][6][7] , especially for novice surgeons. Many novel technologies have been invented to optimize the locking procedure, such as electromagnetic navigation technology, computer-aided navigation technology, orthopedic robots and so on [8][9][10][11][12][13][14][15][16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

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

Gao

Liu

Bai

et al. 2022

Preprint

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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.

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“…Intramedullary nailing is one of the current standard treatments for long bone diaphyseal fractures [1][2][3], however, positioning the distal locking screw is one of the greatest challenges [4][5][6][7], especially for novice surgeons. Many novel technologies have been invented to optimize the locking procedure, such as electromagnetic navigation technology, computer-aided navigation technology, orthopedic robots and so on [8][9][10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Comparison of freehand technique and a novel laser guiding navigation in distal locking of femoral intramedullary nails: a randomized controlled trial

et al. 2022

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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 This randomized controlled single-blind trial recruited patients with femoral diaphyseal fracture. The self-designed laser navigation device (laser group) and freehand technique (FH group) were used in the distal locking of the IMNs. The patients enrolled were randomized into FH group and laser group, 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 ended the study period and 16 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) vs 19.5 (17.25/21) min, Z = 4.83, P < 0.001), distal locking radiation exposure time (46.5 (41.25/51.75) vs 105 (88.25/140) s, 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. Trial registration Chinese Clinical Trial Registry, ChiCTR2200060236. Registered 23 May 2022, https://www.chictr.org.cn/showprojen.aspx?proj=169130

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Free-hand distal locking of intramedullary nails: How to quickly achieve perfect circles without specific instrumentation

Cited by 3 publications

References 19 publications

Technical Trick: Traction Table Assisted Lateral Decubitus Patient Positioning in Cephalomedullary Nailing of Geriatric Intertrochanteric Femur Fractures.

Technical Trick: Traction Table Assisted Lateral Decubitus Patient Positioning in Cephalomedullary Nailing of Geriatric Intertrochanteric Femur Fractures.

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

Comparison of freehand technique and a novel laser guiding navigation in distal locking of femoral intramedullary nails: a randomized controlled trial

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