A mechanical distal aiming device for distal locking in femoral nails.

Although the free hand technique remains the most popular method for distal interlocking screw insertion, proximally mounted radiation independent devices that compensate for implant deformation recently have been developed for the femur. However, the benefits of such systems have not been determined. This study prospectively compared the duration of the nailing procedure, the length of radiation time, and the accuracy of interlocking screw placement when using a radiation independent distal aiming system with those using the free hand technique. In 20 paired intact anatomic specimen femurs, one surgeon experienced only in the free hand technique performed statically locked intramedullary nailing using the two methods. For the aiming system and free hand technique, respectively, the total operation time was 19.1 +/- 8.4 minutes versus 20.9 +/- 11.3 minutes, the distal locking time was 6.6 +/- 2.4 minutes versus 4.8 +/- 1.5 minutes, the total fluoroscopy time was 23 +/- 17 seconds versus 69 +/- 34 seconds, and the distal locking fluoroscopy time was 0 versus 37 +/- 15.5 seconds. There were no failures in either group. Drill nail contact and distal screw damage were greater with the free hand technique. This study suggests that the main advantages of the aiming arm compared with the free hand technique include the elimination of radiation during distal interlocking and more precise screw placement with decreased insertion related hardware damage.

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

[2]  T D Bunker,et al.  Radiation dosage during AO locking femoral nailing. , 1988, Injury.

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

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

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

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

[7]  E J van der Merwe,et al.  Exposure of surgeons-in-training to radiation during intramedullary fixation of femoral shaft fractures. , 1992, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

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

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

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

[11]  T. Dipasquale,et al.  Radiation exposure to the orthopaedic surgical team during fluoroscopy: "how far away is far enough?". , 1997, Journal of orthopaedic trauma.

[12]  C Krettek,et al.  A new technique for the distal locking of solid AO unreamed tibial nails. , 1997, Journal of orthopaedic trauma.

[13]  C. Krettek,et al.  A new mechanical aiming device for the placement of distal interlocking screws in femoral nails , 1998, Archives of Orthopaedic and Trauma Surgery.

[14]  C Krettek,et al.  Deformation of femoral nails with intramedullary insertion , 1998, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.