A new technique for the distal locking of solid AO unreamed tibial nails.

Proximally mounted distal aiming systems have failed primarily because of nail deformation during insertion. A mechanical aiming device for the insertion of distal locking screws for solid unreamed AO tibial nails was developed and was tested in twenty unreamed solid tibial nailing procedures in a video-documented prospective clinical study. The rate of accurate screw placement, time expended, complications, and outcome for each patient were recorded. Distal locking was performed successfully in all cases without image intensification. Although a high percentage (55%) of fractures were open, the total mean operative time was 108 minutes (range, 60 to 180 minutes) and the mean time for distal locking (three screws) was 15.5 minutes (range, 8.0 to 39.0 minutes). Notable drill-nail contact occurred in 15 percent of the distal screws placed, demonstrating accurate aiming and drilling. There were no major intra- or postoperative complications related to the distal aiming system.

[1]  C Krettek,et al.  The deformation of small diameter solid tibial nails with unreamed intramedullary insertion. , 1997, Journal of biomechanics.

[2]  H. Tscherne,et al.  [A new classification of soft-tissue damage in open and closed fractures (author's transl)]. , 1982, Unfallheilkunde.

[3]  R. Gross,et al.  A simplified technique of distal femoral screw insertion for the Grosse-Kempf interlocking nail. , 1988, Clinical orthopaedics and related research.

[4]  S. Kelley,et al.  A Simple Technique for Insertion of Distal Screws into Interlocking Nails , 1995, Journal of orthopaedic trauma.

[5]  M. Davis,et al.  Radiation exposure and associated risks to operating-room personnel during use of fluoroscopic guidance for selected orthopaedic surgical procedures. , 1983, The Journal of bone and joint surgery. American volume.

[6]  C. Krettek,et al.  In vitro and in vivo radiomorphometric analyses of distal screw hole position of the solid tibial nail following insertion. , 1997, Clinical biomechanics.

[7]  S A Riley,et al.  Radiation exposure from fluoroscopy during orthopedic surgical procedures. , 1989, Clinical orthopaedics and related research.

[8]  N. Goddard,et al.  A simple jig to ease the insertion of distal screws in intramedullary locking nails. , 1994, Injury.

[9]  [Laser focusing device for the distal locking of intramedullary nails]. , 1990, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[10]  E. Brug,et al.  [Insertion of distal screws in interlocking nailing using a new free-hand control device]. , 1989, Der Unfallchirurg.

[11]  I. Hudson.  Locking nailing: an aid to distal targetting. , 1989, Injury.

[12]  S Stenzler,et al.  Exposure of the orthopaedic surgeon to radiation. , 1993, The Journal of bone and joint surgery. American volume.

[13]  Method for removal of the fractured stem in total hip replacement. , 1990 .