244. AUTOMATIC DISTAL LOCKING WITH THE SURELOCK INSTRUMENTATION: A NEW CONCEPT OR NOT?

Abstract

Purpose of the study: Since the advent of locked centromedullary nailing, manufacturers have produced long nails with automatic distal locking systems. Astute instrumentations have been developed to achieve highly stable assemblies. But during insertion, the exact shape o the nail may change adapting to the anatomy of the medullary canal. We wanted to test a new automatic distal locking system: Surelock.

Material and methods: We conducted a preliminary monocentric prospective study over a one-month period where we included all cases of reconstruction of the proximal femur using a long nail. The Surelock system was applied systematically. The amplifier was needed to adjust the insertion device, the amplifier and the nail in the same plane. This configuration required manipulation of the amplifier in a single plane. The operator then had to correct the position of the insertion devise in accordance with the deformation of the inserted nail. It is noteworthy that with this system, the operator’s hands are never in the amplifier field. We measured the time required to achieve distal locking and the time of scopy, as well as any complications.

Results: During this period, ten patients had osteosynthesis with a long reconstruction nail. The epidemiological data were common for this type of condition. Mean time for the distal locking was 11 min (7–15) with a mean 17 s of scopy (2–24). In all cases, the two distal screws were inserted. The automatic locking was correct in 9 of 10 cases. The one failure was the second case in our series.

Discussion: In 2006, Whatling concluded a review of the literature on different means for distal locking that the search should continue for an ideal method and that by far the most widely used method was manual locking. The new method presented here for automatic distal locking allows implantation of two distal safety screws. The main benefit is for the surgeon and the manipulator of the amplifier. Radiation of the surgeon is nearly zero (the surgeon remains outside the amplifier field) and the manipulation to position the amplifier is simplified.

Conclusion: We believe that this technique could be used in routine practice and that this method could be proposed for the entire range of nailing procedures.