The development and introduction of the closed locked intramedullary nail into clinical practice has revolutionized the treatment of fractures of long bone. The most difficult and technically demanding part of the procedure is often the insertion of the distal interlocking screws. A lot of efforts have been made during the past years to make it easier. In according with Whatling and Nokes, we can divide the different approaches to this issue in four main groups:

Free-hand (FH) technique;

In addition of these, recently it has been proposed a navigational system using electromagnetic field.

The main disadvantages of the FH technique, are prolonged exposure to radiation and results depend mostly on the dexterity of the surgeons. FH technique is however the most popular technique.

Our targeting device is included into the mounted on image intensifier group. It consists of 2 radio-opaque rods at right angle to each over: one of this is fixed on the c-arm, whereas, the other is a sliding rod with a sleeve for the drill bit, which is the targeting guide itself. In the realization of this device, we have been inspired by the modification of the FH technique suggested by Kelley et al. To identify the distal holes we used the method described by Medoff (perfect circle). Once that the distal hole is seen as a perfect circle, with the C-arm in later view, the targeting guide is roughly positioned onto this and the drilling and the screwing operations are performed without the need for image intensifier. We used the device in bone models and in 9 clinical cases.

In spite of authors demonstrated that the electromagnetic targeting device significantly reduced radiation exposure during placement of distal interlocking screws and was equivalent in accuracy when compared with the FH technique, the latter is the most used technique. Indeed, although all the studies have reported that the radiation exposure to orthopedic surgeon has been below the maximum allowable doses in all cases, there is still the risk of cumulative lifetime radiation exposure. From this point of view, namely the reduction of cumulative lifetime radiation exposure, we think that, paradoxically, our device could be more effective than electromagnetic targeting device, because it can be used in all the orthopedic operations that required a targeting device.

The study of the chondrocyte maturation cycle and endochondral ossification showed that the developing vascular supply has appeared to play a key role in determining the cortical or trabecular structure of the long bones.

The chondrocyte maturation cycle and endochondral ossification were studied in human, foetal cartilage anlagen and in postnatal meta-epiphyses. The relationship between the lacunar area, the inter territorial fibril network variations and CaP nucleation in primary and secondary ossification centres were assessed using light microscopy and SEM morphometry. The anlage topographic, zonal classification derived from the anatomical nomenclature of the completely developed long bone (diaphysis, metaphyses and epiphyses) allowed to follow the development of long bones cartilage model. A significant increase in chondrocyte lacunar area (p<0.001) was documented from the anlage epiphyseal zone 4 and 3 to zone 2 (metaphysis) and zone 1 (diaphysis), with the highest variation from zone 2 to zone 1. An inverse reduction in the intercellular matrix area (p<0.001) and matrix interfibrillar empty space (p<0.001) was also documented. These findings are consistent with the osmotic passage of free cartilage water from the interfibrillar space into the swelling chondrocytes, raising ion concentrations up to the critical threshold for mineral precipitation in the matrix. The mineralised cartilage served as a scaffold for osteoblasts apposition both in primary and secondary ossification centres and in the metaphyseal growth plate cartilage, but at different periods of bone anlage development and with distinct patterns for each zone. They all shared a common initial pathway, but it progressed with different times, modes and organisation in diaphysis, metaphysis and epiphysis. In the ossification phase the developing vascular supply has appeared to play a key role in determining the cortical or trabecular structure of the long bones.