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Gani MH, Liang K, Muzafar K, Dev B, Bhat KA, Ghani A. Outcomes after primary intramedullary nail fixation of open tibial and femoral fractures in low resource settings. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03329-5. [PMID: 35829964 DOI: 10.1007/s00590-022-03329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Open fractures are unique in the urgency they impart to the injury and the therapeutic challenge they pose. Non-union and infection are among the major concerns. Open tibial and femoral shaft fractures are among the commonest orthopaedic urgencies. Primary intramedullary (IM) nailing requires a skillset and knowledge of the principles of open fracture management and also a well-equipped operating room with the necessary implants and instruments. In a low resource setting, one or more of these prerequisites may not be met, and the outcome may thus be affected similarly. The objective of this study was to study these outcomes. METHODS We prospectively studied primary IM nailing of open 1, 2 and 3A tibial and femoral fractures done in our hospital, in a simple non-modular operating room without an image intensifier. RESULTS There were 106 fractures in 104 patients: 93 tibial and 13 femoral. The mean time from injury to surgical debridement was 19.6 h. Mean duration of antibiotics therapy was 4.3 days, and the mean duration of hospital stay was 4.1 days. All patients were followed up to union. Mean time to radiographic union was 6.1 months for the tibia and 5.7 months for the femur. Non-union was seen in 4 tibial and 1 femoral fractures. There were 3 superficial infections but no deep infection. CONCLUSION The outcomes were comparable to, and in some cases better than, those found in existing literature. We conclude that primary IM nailing in open long bone fractures can be performed in austere environments with good success, in expert hands if the principles are adhered to.
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Affiliation(s)
| | - Kaifeng Liang
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Khalid Muzafar
- Department of Orthopaedics, Government Medical College, Doda, Jammu & Kashmir, India
| | - Bias Dev
- Department of Orthopaedics, Government Medical College Jammu, Jammu, Jammu & Kashmir, India
| | | | - Abdul Ghani
- Department of Orthopaedics, Government Medical College Jammu, Jammu, Jammu & Kashmir, India
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“Turning The Tables”: A Technical Tip to Overcome Anatomic Constraints While Distal Locking During Femur Intramedullary Nailing. Tech Orthop 2022. [DOI: 10.1097/bto.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maleki M, Tehrani AF, Aray A, Ranjbar M. Intramedullary nail holes laser indicator, a non-invasive technique for interlocking of intramedullary nails. Sci Rep 2021; 11:21166. [PMID: 34707138 PMCID: PMC8551185 DOI: 10.1038/s41598-021-00382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/12/2021] [Indexed: 11/09/2022] Open
Abstract
Interlocking of intramedullary nails is a challenging procedure in orthopedic trauma surgery. Numerous methods have been described to facilitate this process. But they are exposed patient and surgical team to X-rays or involves trial and error. An accurate and non-invasive method has been provided to easily interlocking intramedullary nails. By transferring a safe visible light inside the nail, a drilling position appears which use to drilling bone toward the nail hole. The wavelength of this light was obtained from ex-vivo spectroscopy on biological tissues which has optimal transmission, reflectance, and absorption properties. Moreover, animal and human experiments were performed to evaluate performance of the proposed system. Ex-vivo performance experiments were performed successfully on two groups of cow and sheep samples. Output parameters were procedure time and drilling quality which there were significant differences between the two groups in procedure time (P < 0.05). But no significant differences were observed in drilling quality (P > 0.05). Moreover, an In-vivo performance experiment was performed successfully on a middle-aged man. To compare the provided method, targeting-arm, and free-hand techniques, two human experiments were performed on a middle-aged and a young man. The results indicate the advantage of the proposed technique in the procedure time (P < 0.05), while the drilling quality is equal to the free-hand technique (P = 0.05). Intramedullary nail holes laser indicator is a safe and accurate method that reduced surgical time and simplifies the process. This new technology makes it easier to interlocking the intramedullary nail which can have good clinical applications.
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Affiliation(s)
- Mohammadreza Maleki
- Department of Mechanical Engineering, Isfahan University of Technology, 84156-83111, Isfahan, Iran.
| | - Alireza Fadaei Tehrani
- Department of Mechanical Engineering, Isfahan University of Technology, 84156-83111, Isfahan, Iran
| | - Ayda Aray
- Department of Physics, Isfahan University of Technology, 84156-83111, Isfahan, Iran
| | - Mehdi Ranjbar
- Department of Physics, Isfahan University of Technology, 84156-83111, Isfahan, Iran
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Prasad BK, Jain R, Kumar A. Tibia Nailing Without C-Arm Guidance: Challenges and Successes. Cureus 2021; 13:e16797. [PMID: 34513403 PMCID: PMC8405380 DOI: 10.7759/cureus.16797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose There are increased trends in the last two to three decades to operate tibia fractures to ensure acceptable reduction over long period of time and to ensure early mobilization and return to work. This leads to frequent use of C-arm to perform the procedures. The purpose of our study is to reduce the exposure of radiation to the patient and healthcare workers during closed nailing of fractures. Methods and materials This is an institute-based retrospective cohort study. Patients operated with tibia interlocking nailing between November 2016 and November 2018 were shortlisted from the OT records. Seventy-six patients were shortlisted and their clinical records were retrieved. Fifty-eight patients fulfilling the inclusion criteria were included in the study. 28 patients had Tibia interlocking nailing done without using C-arm and 30 patients had tibia interlocking nailing done under C-arm guidance. IBM SPSS software was used to compare data between the groups using Chi-square test and Independent T-test with a 95% confidence interval to determine the significance. Results All the patients progressed to the union by six months of surgery. Average blood loss, Infection rates and time to union in both the groups were comparable. Though the average duration of surgery was significantly higher in non-C-arm group as compared to with C arm group, when the duration of individual surgeries was analysed and plotted sequentially on a chart, we found it was comparable in later cases. Conclusions With adequate practice, tibial nailing without C-arm is easy, requires minimal manpower, equipment and can also prove to be a lifesaver in case of equipment failure.
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Affiliation(s)
- Brejesh K Prasad
- Orthopaedics, Employees' State Insurance Corporation Medical College, Faridabad, IND
| | - Rahul Jain
- Orthopaedics, Employees' State Insurance Corporation Medical College, Faridabad, IND
| | - Amit Kumar
- Orthopaedics, All India Institute of Medical Sciences, Raebareli, IND
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On the Challenges of Anesthesia and Surgery during Interplanetary Spaceflight. Anesthesiology 2021; 135:155-163. [PMID: 33940633 DOI: 10.1097/aln.0000000000003789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rodriguez T, Laborde A, Khédira T, Ledoux D, Hamitouche K. Free-hand distal locking of intramedullary nails: How to quickly achieve perfect circles without specific instrumentation. Orthop Traumatol Surg Res 2021; 107:102831. [PMID: 33524628 DOI: 10.1016/j.otsr.2021.102831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 09/17/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Intramedullary locked nails are mainly used for the fixation of mid-shaft fractures in the long bones. But inserting the distal locking screws by the free-hand technique may require high exposure to radiation. Our method achieves perfect circles on radiographs on the first attempt for lower limb fractures without any specific instrumentation. SURGICAL TECHNIQUE We applied a geometric principle in which two lines perpendicular to another line are parallel to each other. Proximal locking, whether it is done or not, serves as a guide for the first perpendicular line to the nail. The fluoroscopy unit is aligned along the drill sleeve or the screwdriver left in place to achieve perfect circles on the first attempt. DISCUSSION This technique is simple, reliable, and reproducible. It does not require any specific instrumentation, allows the surgeon to choose any manufacturer's nail and reduces the operating room staff's exposure to radiation.
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Affiliation(s)
- Thibaud Rodriguez
- Service de chirurgie orthopédie et traumatologie, Clinique Beau Soleil, 119, avenue de Lodève, 34070, Montpellier, France.
| | - Alexandre Laborde
- Service de chirurgie orthopédie et traumatologie, Clinique Beau Soleil, 119, avenue de Lodève, 34070, Montpellier, France
| | - Tarek Khédira
- Service de chirurgie orthopédie et traumatologie, Clinique Beau Soleil, 119, avenue de Lodève, 34070, Montpellier, France
| | - Didier Ledoux
- Service de chirurgie orthopédie et traumatologie, Hôpitaux des Bassins de Thau, boulevard Camille Blanc, 34200, Sète, France
| | - Kamel Hamitouche
- Service de chirurgie orthopédie et traumatologie, Hôpitaux des Bassins de Thau, boulevard Camille Blanc, 34200, Sète, France
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Huichao F, Xiaoming W. Reduced Surgical Time and Higher Accuracy of Distal Locking with the Electromagnetic Targeting System in Humeral Shaft Intramedullary Nailing. Orthop Surg 2020; 12:1413-1420. [PMID: 32893489 PMCID: PMC7670153 DOI: 10.1111/os.12785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 01/25/2023] Open
Abstract
Objective To evaluate the efficacy of the electromagnetic distal targeting system in the treatment of humeral shaft fractures. Methods From January 2012 to December 2018, we retrospectively reviewed 60 patients with humeral shaft fractures treated by intramedullary nailing. Among 60 cases, 41 were men and 19 were women. The average age at surgery was 48.5 years (range, 21–81 years). We performed the same surgical procedure for all patients. According to the different distal locking technique used, all patients were divided into two groups. The standard fluoroscopic freehand technique was used for Group FH, while the electromagnetic real‐time targeting technique was used for Group EM. All procedures were performed by two senior surgeons. Overall surgical time, cases of complications, failure of distal locking, union time, and shoulder function assessment were recorded intraoperatively and during follow‐up. Results Twenty‐seven patients in Group FH and 33 patients in Group EM met the inclusion criteria. No significant difference was found in the demographic data of the two groups. The mean surgical time was 76.48 ± 10.73 min in Group FH and 65.61 ± 8.91 min in Group EM (P < 0.05), showing significant difference. Seven failures occurred in Group FH and two failures occurred in Group EM (P < 0.05). No relevant complications were noted. The average union time was 3.37 ± 0.49 months in Group FH and 3.39 ± 0.50 months in Group EM (P = 0.855). The mean follow‐up was 14.30 ± 2.28 months in Group FH and 15.27 ± 2.83 months in Group EM (P = 0.153). The disabilities of the arm, shoulder and hand score (DASH) score, the range of motion (checked with the constant score), and the degree of functionality were, respectively, 21.52 ± 3.23, 27.04 ± 1.84, and 81.31% ± 3.88% in Group FH and 19.09 ± 2.40, 26.18 ± 1.70, and 77.97% ± 3.91% in Group EM (P = 0.233, 0.971, and 0.607). Conclusion The electromagnetic real‐time targeting system reduced surgical time and improved accuracy, and there was no radiation exposure in the distal locking procedure for humeral shaft fractures.
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Affiliation(s)
- Fu Huichao
- Department of Orthopaedic Traumatology, Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu Xiaoming
- Department of Orthopaedic Traumatology, Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ferreira N, Nieuwoudt L. Preliminary Results with the Shape Memory Nail: A Self-contained Distal Locking Mechanism for Diaphyseal Femur Fractures. Strategies Trauma Limb Reconstr 2020; 14:115-120. [PMID: 32742425 PMCID: PMC7368356 DOI: 10.5005/jp-journals-10080-1437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Distal interlocking of intramedullary nails can be challenging if not done regularly and can be associated with a prolonged operating time and excessive radiation exposure. Multiple techniques have been developed to overcome these problems but all still rely on conventional distal locking methods. Between December 2011 and March 2013, 18 patients with diaphyseal femur fractures were treated with the shape memory nail (Orthofix, Verona, Italy). These nails use self-contained nitinol memory metal ‘wings’ at the distal aspect of the nail to provide rotational and longitudinal stability. We observed fracture union in all 18 cases with no non-unions, rotational malalignments or peri-prosthetic infections. Median theatre time was 35 (18–71) minutes and median total radiation time was 50 (20–209) seconds. The shape memory nail (Orthofix, Verona, Italy) is an attractive alternative to conventional interlocking femoral nails. It provides sufficient stability to allow fracture union while decreasing theater time and limiting radiation exposure.
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Affiliation(s)
- Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luan Nieuwoudt
- Department of Orthopaedic Surgery, University of Kwa-Zulu Natal, Pietermaritzburg, South Africa
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Azim FAA. Radiation-Independent Distal Locking Screw Insertion using Dual Nail Insertion Handle: Is It a Reliable Method? JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2017. [DOI: 10.1016/j.jotr.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background There are continuous trials to get radiation-independent distal locking to avoid the hazards of radiation exposure. Patients and Methods Thirty cases of diaphyseal tibial fractures were fixed with locked intramedullary nail. A new dual nail insertion handle was used for insertion of the locking screws from distal to proximal position. Results Success rate was much improved with extra reaming. Failure rate was 20%. Conclusion This technique is not reliable enough to replace the classic radiation-dependent free-hand technique. Further development of this idea is needed to get a perfect radiation-independent distal locking technique.
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Affiliation(s)
- Foda Adel Abdel Azim
- Faculty of Medicine, Zagazig University and Zagazig University Hospitals, Zagazig, Egypt
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Zhu Y, Chang H, Yu Y, Chen W, Liu S, Zhang Y. Meta-analysis suggests that the electromagnetic technique is better than the free-hand method for the distal locking during intramedullary nailing procedures. INTERNATIONAL ORTHOPAEDICS 2016; 41:1041-1048. [DOI: 10.1007/s00264-016-3230-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
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Rueger JM, Rücker AH, Hoffmann M. [Suprapatellar approach to tibial medullary nailing with electromagnetic field-guided distal locking]. Unfallchirurg 2015; 118:302-10. [PMID: 25835205 DOI: 10.1007/s00113-014-2669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Closed tibial shaft fractures are the domain of intramedullary nailing. With the introduction of new nail designs and technologies, even small, dislocated distal fragments can be anatomically aligned and safely fixed. Unsolved or to a lesser degree controlled are the problems of distal locking in the freehand technique, which can still be difficult and can lead to a significant radiation exposure, and how to control very short proximal tibial fragments in metaphyseal tibial fractures or tibial segmental fractures, where the proximal fracture line also runs through the metaphysis.By using a suprapatellar approach, i.e. a skin incision proximal to the patella with an entry point into the tibial bone from within the knee at the same site as for a standard infrapatellar approach, and then nailing the tibia in a semi-extended position, i.e. the knee is only flexed 10-20°, the intraoperative dislocation of a short proximal fragment can be avoided. The main indications for semi-extended tibial nailing are a short diaphyseal fragment in an isolated tibial shaft fracture, a segmental fracture where the proximal fracture line is metaphyseal and in patients where infrapatellar soft tissues are compromised.The use of the electromagnetic guidance system SureShot® generates reliable and reproducible results, reduces the operating time and is independent from radiation for distal locking.
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Affiliation(s)
- J M Rueger
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland,
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Ehlinger M, Dillman G, Czekaj J, Adam P, Taglang G, Brinkert D, Schenck B, Di Marco A, Bonnomet F. Distal targeting device for long Gamma nail(®). Monocentric observational study. Orthop Traumatol Surg Res 2013; 99:799-804. [PMID: 24095597 DOI: 10.1016/j.otsr.2013.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/06/2013] [Accepted: 06/27/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intramedullary nail distal locking screws make it possible to control length and rotation but include an increased risk of radiation exposure. A distal targeting device was recently developed for long Gamma(®) nails (Stryker(®)). The aim of this practical observational study was to evaluate the reliability of this system. Our hypothesis was that the targeting device would be systematically used without conversion or complications. MATERIALS AND METHODS All of the long Gamma(®) nails implanted between November 2011 and October 2012 were recorded: 91 nails (59W/32M, mean age 73.5years old) for 68 traumatic fractures, 14 preventive nailings and nine pathological fractures. A junior surgeon performed the procedure in 45 cases and a senior in 46 cases. The number of times the device was used, the difficulties and complications encountered, the duration of fluoroscopy and the dose of radiation were noted. Risk factors were looked for. RESULTS The targeting device was used 79 times (the surgeon chose not to use it 11 times, and it was not available in one case). There was a measurement error in one case, therefore 78 nails could be evaluated. Three wrong positions of the distal locking screw occurred. No statistically significant risk factors were identified. Distal locking screw corresponded to 18% of the entire procedure at a radiation dose of 7.44% (this was higher with titanium nails and pathological fractures). Total fluoroscopy time was longer with junior than with senior surgeons but the dose and duration for distal locking were not different. DISCUSSION The hypothesis was not confirmed. The device was not systematically used and the risk of complications was not null. No risk factors were identified. The distal locking screw is a difficult step but the use of the targeting device can limit the dose of radiation. This device is effective and allows young surgeons to perform distal locking without increasing the dose of radiation compared to senior surgeons. LEVEL OF EVIDENCE Level IV, cohort study, observational prospective follow-up.
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Affiliation(s)
- M Ehlinger
- Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Distal locking using an electromagnetic field-guided computer-based real-time system for orthopaedic trauma patients. J Orthop Trauma 2013; 27:367-72. [PMID: 23429175 DOI: 10.1097/bot.0b013e31828c2ad1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the efficacy of distal interlocking during intramedullary nailing using a freehand technique versus an electromagnetic field real-time system (EFRTS). DESIGN A prospective, randomized controlled trial. SETTING Level I academic trauma center. PATIENTS/PARTICIPANTS Patients older than 18 years who sustained a femoral or tibial shaft fracture amenable to antegrade intramedullary nailing were prospectively enrolled between August 2010 and November 2011. Exclusion criteria included injuries requiring retrograde nailing and open wounds near the location of the distal interlocks (distal third of the femur, knee, or distal tibia). INTERVENTION Each patient had 2 distal interlocking screws placed: one using the freehand method and the other using EFRTS. MAIN OUTCOME MEASUREMENT Techniques were compared on procedural time and number of interlocking screw misses. Two time points were measured: time 1 (time to find perfect circles/time from wand placement to drill initiation) and time 2 (drill initiation until completion of interlocking placement). RESULTS Twenty-four tibia and 24 femur fractures were studied. EFRTS proved faster at times 1 and 2 (P < 0.0001 and P < 0.0002) and total time (P < 0.0001). This difference was larger for junior residents, though reached statistical significance for senior residents. Senior residents were faster with the freehand technique compared with junior residents (P < 0.004), but the 2 were similar using EFRTS (P = 0.41). The number of misses was higher with free hand compared with EFRTS (P = 0.02). CONCLUSION These results suggest that EFRTS is faster than the traditional freehand technique and results in fewer screw misses. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Abstract
OBJECTIVE This study was designed to compare the accuracy, time, and radiation exposure during the insertion of intramedullary nail locking screws using either standard fluoroscopic assistance or an electromagnetic (EM)-based navigational system without fluoroscopy. DESIGN Prospective. SETTING Level I academic trauma center. METHODS Patients were divided into 2 groups: group 1 (fluoroscopic assistance), consisted of standard freehand fluoroscopically assisted insertion of locking screws (OEC 9900; G.E. HealthCare, Waukesha, WI), whereas group 2 (EM), consisted of EM navigationally assisted insertion without fluoroscopy (SureShot; Smith & Nephew, Memphis, TN). Technician arrival time, setup (SU) time, screw insertion (SI) time (seconds), fluoroscopy time (seconds), radiation exposure (mrads), and accuracy (hit or miss) were recorded for each screw. For group 1, the SU time was recorded as the time and radiation required to obtain "perfect circles" before insertion, and for group 2, the SU time was recorded as the time required to set up the navigational EM unit. Data collected regarding SI were then compared using standard analysis of variance. RESULTS Forty-one locking screws were inserted in group 1, whereas 60 screws were inserted in group 2. Accuracy was 100% for both groups. For group 1, mean technician wait time was 77 seconds plus a mean perfect circle SU time of 105 seconds (9.2 mrads and 10 seconds of fluoroscopy). Mean SU time for group 2 was 94 seconds (no fluoroscopy). Mean insertion time was 342 seconds per screw for group 1 (32.9 mrads and 18 seconds of fluoroscopy) compared with 234 seconds per screw for group 2 (no fluoroscopy). These differences were statistically significant (P = 0.006). CONCLUSIONS The use of EM navigation (SureShot; Smith & Nephew) for the insertion of intramedullary nail locking screws demonstrated accuracy similar to conventional fluoroscopic-guided insertion. However, EM-guided locking SI resulted in a significantly shorter total procedural time and completely eliminated radiation exposure. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Negrin LL, Vécsei V. Is a magnetic-manual targeting device an appealing alternative for distal locking of tibial intramedullary nails? ARCHIVES OF TRAUMA RESEARCH 2013; 2:16-20. [PMID: 24396784 PMCID: PMC3876508 DOI: 10.5812/atr.10638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 02/26/2013] [Accepted: 03/02/2013] [Indexed: 11/22/2022]
Abstract
Background In order to enable a radiation-free, accurate and simple positioning of distal locking screws, a combined magnetic and manual targeting system has been developed by Sanatmetal®. Where a low-frequency magnetic field is initially used to detect the position of the first drill hole and three more holes can be found with a mechanical template. Objectives Our cadaver study was performed to evaluate the accuracy and efficiency of this device. Materials and Methods In two runs, 30 probands (group 1: 10 students; group 2: 10 residents; group 3: 10 attendings), none of who being familiar with the device, tested the radiation-free system using 60 intact cadaver tibias. Each proband performed the surgical procedure twice in succession. Results Referring to the first attempts, 9.6, 7.2 and 7.1 minutes were the time periods required to insert the four distal screws and the relevant values for the second attempts were 8.6, 6.3 and 6.2 minutes; in both cases revealing a significant difference between group 1 and 2 and group 1 and 3. Furthermore, the mean values within each group indicated a significant decrease of the test duration. Out of the 240 drillings, only one failure (group 1) occurred, representing an accuracy of 99.58 %. Of the probands, 90 % rated the targeting device better than the free-hand technique and 77 % at least attested a high user-friendliness. Conclusions Due to our satisfactory test results, the brief training, the steep learning curve and the radiation-free technique the new device has to be considered an appealing alternative for distal locking.
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Affiliation(s)
- Lukas L. Negrin
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
- Corresponding author: Lukas L. Negrin, Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria. Tel: +43-1404005901, Fax: +43-1404005939, E-mail:
| | - Vilmos Vécsei
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
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Next generation distal locking for intramedullary nails using an electromagnetic X-ray-radiation-free real-time navigation system. J Trauma Acute Care Surg 2012; 73:243-8. [DOI: 10.1097/ta.0b013e31824b0088] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soni RK, Mehta SM, Awasthi B, Singh JL, Kumar A, Thakur L, Tripathy SK. Radiation-free Insertion of Distal Interlocking Screw in Tibial and Femur Nailing: A Simple Technique. J Surg Tech Case Rep 2012; 4:15-8. [PMID: 23066456 PMCID: PMC3461770 DOI: 10.4103/2006-8808.100346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Ritesh Kumar Soni
- Department of Orthopaedics, Dr. Rajender Prasad Government Medical College (RPGMC) Tanda, Kangra, India
- Address for correspondence: Dr. Ritesh Kumar Soni, Senior Resident, Department Of Orthopedics, Dr. RPGMC, Tanda, Kangra, H.P. – 176 001, India. E-mail:
| | - Surender Mohan Mehta
- Department of Orthopaedics, Dr. Rajender Prasad Government Medical College (RPGMC) Tanda, Kangra, India
| | - Bhanu Awasthi
- Department of Orthopaedics, Dr. Rajender Prasad Government Medical College (RPGMC) Tanda, Kangra, India
| | - Janith Lal Singh
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Kumar
- Department of Orthopaedics, Government Medical College, Chandigarh, India
| | - Lokesh Thakur
- Department of Orthopaedics, Dr. Rajender Prasad Government Medical College (RPGMC) Tanda, Kangra, India
| | - Sujit Kumar Tripathy
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Rohilla R, Singh R, Rohilla S, Magu NK, Devgan A, Siwach R. Locked intramedullary femoral nailing without fracture table or image intensifier. Strategies Trauma Limb Reconstr 2011; 6:127-35. [PMID: 22081272 PMCID: PMC3225568 DOI: 10.1007/s11751-011-0122-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 10/31/2011] [Indexed: 12/01/2022] Open
Abstract
The present retrospective study aims to evaluate the outcome in 41 patients of femoral shaft fractures, who had closed intramedullary nailing in lateral decubitus position without fracture table or image intensifier. Mean age was 33.2 (range, 18-70) years. The cannulated reamer in proximal fragment (as intramedullary joystick) and Schanz screw in the distal fragment (as percutaneous joystick) were simultaneously used to assist closed reduction of the fracture without the use of image intensifier. Closed reduction was successful in 38 patients. Open reduction was required in 3 patients. Schanz screw was used for closed reduction in 12 patients. Average number of intra-operative radiographic exposures was 4.4. Two patients had exchange nailing using large diameter nails. One patient had nonunion. Angular and rotatory malalignments were observed in seven patients. We are of the opinion that the present technique is a safe and reliable alternative to achieve closed locked intramedullary nailing and is best suited to stable, less comminuted (Winquist-Hansen types I and II) diaphyseal fractures of the femur.
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Affiliation(s)
- Rajesh Rohilla
- Department of Orthopaedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, 9 J/28, Medical Enclave, Rohtak, Haryana, 124001, India,
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Ozkan K, Unay K, Demircay C, Cakir M, Eceviz E. Distal unlocked proximal femoral intramedullary nailing for intertrochanteric femur fractures. INTERNATIONAL ORTHOPAEDICS 2008; 33:1397-400. [PMID: 18956183 DOI: 10.1007/s00264-008-0673-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Accepted: 09/14/2008] [Indexed: 02/06/2023]
Abstract
We investigated whether a proximal femoral nail (PFN) having two lag screws can be implanted without distal locking screws in AO/OTA 31-A1 and 31-A2 intertrochanteric femur fractures. Twenty-four patients with AO/OTA 31-A1 and 31-A2 fractures were treated with a PFN without distal interlocking by a single surgeon. The mean follow-up was 12 months (range: 7-23). Clinical and functional outcome was assessed according to the Harris hip score and Barthel's activity score. The fractures healed in all patients; the average consolidation time was 14 weeks (range: 9-28). Fourteen patients had excellent and good results, nine patients had fair results, and one patient had a poor result according to the Harris hip score; 17 patients had a high range of mobility according to the Barthel activity score. Our results suggested that the PFN can be successfully implanted without distal interlocking in 31-A1 and 31-A2 fractures.
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Affiliation(s)
- Korhan Ozkan
- Orthopaedic and Traumatology Department, Goztepe Research and Training Hospital, Istanbul, Turkey.
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