Abstract
Purpose of study
The addition of interlocking screws to intramedullary nails adds greatly to the stability of these constructs, yet the placement of distal screws accounts for a significant proportion of the total fluoroscopy and operative times. The Sureshot® (Smith and Nephew™) is a computerised system that allows placement of distal screws without fluoroscopy by using electromagnetic guided imagery. The purpose of this study is to compare traditional free-hand technique to the Sureshot® technique in terms of operating time, radiation dose and accuracy.
Methods
Between September 2011 and March 2012 we prospectively randomised 66 consecutive patients presenting to us with femur shaft fractures requiring intramedullary nails to either free-hand (n=33) or Sureshot® assisted (n=28) distal locking. Fractures warranting only one distal locking screw, or those requiring retrograde or cephalo-medullary nailing, were excluded. Five patients' data was not suitable for analysis. The two groups were assessed for distal locking time, distal locking radiation and accuracy of distal locking.
Results
The average total operative time was 51 minutes (range 25–88) for the free-hand group and 59 minutes (range 40–103) for the Sureshot® group. The average time for distal locking time was 10 minutes (range 4–16) with free-hand and 11 minutes (range 6–28) with Sureshot®. The average radiation dose for distal locking was 746.27 μGy (range 200–2310) for the free-hand group and 262.54 μGy (range 51–660) for the Sureshot® group. There were 2 misplaced drill bits in the free-hand group and 3 in the SureShot® group.
Conclusion
SureShot® assisted distal locking reduces radiation exposure, but in a high-volume institution like ours it didn't reduce operative time or improve our accuracy. The benefits of this reduction in radiation still need to be quantified. The slightly higher number of misplaced drill bits and screws may represent our learning curve with SureShot®.
NO DISCLOSURES
