Training Distal Locking Screw Insertion Skills to Novice Trainees

Leroux, Timothy; Khoshbin, Amir; Nousiainen, Markku

doi:10.1097/bot.0000000000000349

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…For these surgeons, the electromagnetic technique is an effective and accessible method because it is radiation-independent and has a short learning curve. This viewpoint was confirmed by Leroux et al [22] The ET technique is one of the most common and effective methods, although many other methods have been developed to settle the problems of free-hand distal locking.…”

Section: Discussionmentioning

confidence: 79%

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

Han

Shi

et al. 2017

Medicine

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Background:Although the method has been used widely, one of the greatest challenges for intramedullary nailing is to position the distal locking screw. A new technology, the electromagnetic navigation system, is a radiation-free way to locate the position of the drill bit and provide 3-dimensional real-time feedback of location and orientation of the drill bit relative to the locking holes. The purpose of our study was to evaluate the reliability and efficiency of the free-hand technique compared to the new electromagnetic navigation system.Methods:Fifty-four patients with femoral fracture who needed treatment with intramedullary nails were divided into 2 groups. One group including 26 patients underwent distal locking using the standard free-hand method, whereas the electromagnetic navigation system was used with the other 29 patients. Intraoperative fluoroscopy exposure times, screw insertion times, and healing times were recorded; these parameters were used for comparison between the 2 groups.Results:There were 17 males and 9 females who had femoral intramedullary nails using the free-hand technique, whereas 21 males and 8 females received intramedullary nails using the electromagnetic navigation system. The mean time of distal locking was 19.5 ± 6.0 minutes in the free-hand (FH) group, whereas the time was 6.1 ± 1.4 minutes in the electromagnetic (ET) group. The exposure time for the FH group was 26.8 ± 13.3 seconds and 2.2 ± 1.1 seconds for the ET group. Healing time proved to be comparable in the FH and ET groups (16.4 ± 3.7 weeks vs 15.1 ± 2.8 weeks).Conclusion:Under the premise of achieving the same effect, the electromagnetic navigation system has the advantage of less distal locking time and less radiation dose.

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Section: Discussionmentioning

confidence: 79%

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

Han

Shi

et al. 2017

Medicine

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“…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.…”

Section: Resultsmentioning

confidence: 99%

Imaging in Fracture surgeries - a tool for quality assessment

Ramanathan¹,

lourdes²

2020

ijrps

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Radiation in orthopaedic surgeries was considered to be commonly hazardous, but also can be used as tool to improvise the surgical skills, limitations of exposure, risk analysis and making of alternate arrangements whenever required. We aim to analyse the number of times of imaging taken intra-operatively with C-arm for all acute closed lower limb fractures, which are all electively planned for intramedullary nailing ixation. It was a single centre, prospective randomized control double blind study, acute closed single plane fracture of lower limb like tibia shaft fracture, femur shaft fracture and intertrochanteric fracture electively posted for intramedullary nailing ixation were included. Total of 168 fractures, 38 intertrochanteric fractures (22.61%), 52 femur shaft fractures (30.95%), 78 tibia shaft fractures (46.42%) were electively planned for nailing ixation with intra-operative image guidance. Mean age was 42 which was statistically signi icant. Males were more than females, (89 male 52.97% and 79 female 47.02%) observed to be statistically not signi icant. Right lower limb 90 (53.57%) was observed to be more injured than the left lower limb 78(46.42%) which was statistically not signi icant (p<0.56). Mean imaging for intramedullary ixation in intertrochanteric fractures was 75 (17.30%) , femur 120 (37.76%) and tibia 95 (44.93%) was observed to be statistically signi icant. Radiation in orthopaedic surgeries can be otherwise and also be utilized by operating primary trauma surgeon with focus on average number of imaging for the elective nailing procedure as a self-monitoring tool for skill improvement with reproducible potential, radiation minimisation, call for help and technical improvisation for the future years, besides its occupational ill effects.

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“…More recent literatures [ 22 , 23 ] have shown the simultaneously expanded feedback offered by the newer technology is likely to be an useful tool to teach surgical techniques and doesn’t do harm to learning. Basing on this presupposition, Leroux et al [ 24 ] conduct a trial to make a comparison on what will the fluoroscopy or electromagnetic (EM) guidance bring to the surgical new hands’ studying about the locking of inserting screw in tibial nails. In the techniques of distaling the locking of screw insertion, the EM guidance is of great importance to the training of surgical new hands.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Training Distal Locking Screw Insertion Skills to Novice Trainees

Abstract: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 5 publications

References 16 publications

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

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

Imaging in Fracture surgeries - a tool for quality assessment

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

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