INSERTING DISTAL SCREWS INTO INTERLOCKING NAILS: A NEW TECHNIQUE

Abstract

Aim: Accurate placement of the distal screws into the interlocking nails is a demanding procedure due in part to inaccuracy of the targeting device supplied with the system and to deformation of the nail during insertion. Distal locking can be time consuming and expose the surgeon to unnecessary increased ionization radiation. The described technique allows the distal femoral screw holes to be localized accurately with minimal radiation exposure. Our technique requires no aiming device and no assistant. The only equipment needed is another IM nail at the same length.

Materials and Methods: We describe our new protocol in a subgroup of 20 patients, among those attended to our institution during the last 1.5 years treated with reamed, locked intramedullary nailing. After placement of the nail in a tibia or femur, a second interlocking nail at the same length is placed along side the limb. Using the proximal insertion jig provided with the system, proximal holes of the internal nail are locked with long screws passing through the nail-mounted outrigger to the far cortex. After avoiding the outrigger motion and rod torsion, distal screws are locked. Proximal holes’ locking is then accomplished.

Results: In 20 consecutive distally locked nailing (eight tibiae and 12 femora), the technique was easily mastered. In the operation, there had been taken antero-posterior and lateral graphies in order to evaluate the reduction, the length of the nail and the screws.

Conclusion: The advantages of this protocol are; decreasing the roentgenogram exposure and minimizing the operating time when compared to freehand techniques. This technique can be a safe alternative to the common distal targeting techniques. It can be used when an image intensifier is unavailable.