Radiation-free insertion of distal interlocking screw in tibial and femur nailing: A simple technique

Abstract

Background:Distal interlocking screw insertion in intramedullary nailing of long-bone fracture is a challenging task for orthopedic surgeons. It is difficult particularly when the surgeon is in his learning stage or when image intensifier is not available. We describe a radiation-free technique of distal interlocking screw insertion which is easy and practicable.Materials and Methods:In this technique, a same length nail is placed over the skin (outer nail) and through its distal-most screw hole, a 3.2 mm drill bit is inserted to drill the distal locking screw hole of the intramedullary nail (inner nail). With a small skin incision over the distal screw holes, the distal-most screw hole is identified; the bone window overlying the screw hole is widened with an awl and a locking bolt is inserted with a washer under direct visualization. The other distal interlocking screw is simply drilled by matching the other three holes of the outer and inner nails. We have operated 86 patients (39 femoral shaft fracture and 47 tibial shaft fracture) in 1 year where this technique was used. There were 41 open fracture and 45 closed fracture.Results:Within 6 months of follow-up, bony union was achieved in 36 of 39 femur fractures and 45 of 47 tibial fractures. No unwanted complications were observed during the postoperative period and in follow-up.Conclusion:This method of radiation-free distal interlocking screw insertion is simple and can be used in third world country where image intensifier facility is not available. However, surgeons are encouraged to use image intensifier facility where the facility is available.

Does electromagnetic guidance system superior to free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study

“…[21] In addition, inexpensive and simple methods that reduce radiation exposure and do not require fluoroscopy have also been described. [2,14] Soni RK et al [14] reported that 45 of 47 tibial shaft fractures that they operated with an easy, applicable and no-radiation distal locking screw insertion technique showed complete union and no complications occurred during six months of follow-up. Aldemir et al [2] reported that they operated on 578 tibial fractures without using fluoroscopy with three locking techniques and two control methods, which they described with long years of experience in a very large series, and that failure in the distal locking was seen in only one patient.…”

“…[2,3] On the other hand, inexpensive and simple FHTs, which reduce radiation exposure in distal screwing, have been described. [2,14] In this study, we aimed to compare the results of FHT and EMGS results of the distal locking method concerning surgery duration and radiation exposure in patients who underwent osteosynthesis of tibia fractures with IMN.…”

Double Segmental Tibial Fracture: Case Report with Review of Literature

“…Smallest available cannulated nail of 8 millimeters size was passed over guide-wire. Distal locking was done free hand using technique described by Soni and Mehta et al [2]. Proximally two bolts were inserted with jig [ Fig.3].…”

Preliminary Results with the Shape Memory Nail: A Self-contained Distal Locking Mechanism for Diaphyseal Femur Fractures

“… 6 Rohilla et al and Soni et al described the nail-over-nail technique to simplify distal locking and decrease radiation exposure. 7 , 12 Nail mounted jig techniques have been developed by multiple companies, including Orthofix (Verona, Italy), Stryker (Kalamazoo, Michigan), Synthes (Zuchwil, Switzerland) and the surgical implant generation network (SIGN) nail. 13 – 18 The inherent problem with these nail-mounted techniques is the slight deformation that femoral nails undergo during insertion into the intramedullary canal.…”