A distal-lock electromagnetic targeting device for intramedullary nailing: Suggestions and clinical experience

Abstract

PurposeTo describe our clinical experience with a system named SureShot™ Distal Targeting (Smith & Nephew, Memphis, USA) based on magnetic field presence and discuss our suggestions on this technique.MethodsWe analysed prospectively 47 patients affected by humeral, tibial or femoral fractures, treated in our institution during a 3-year period of time (August 2010 to September 2013). We considered the following parameters: the time to set up, the time to position a single screw, the effectiveness of the system (drilling ad screwing), the irradiation exposure time during distal locking procedure and surgical complications.ResultsA total number of 96 screws were inserted. The mean preparation time of the device was 5.1 min ± 2 min (range 3–10 min). The mean time for single screw targeting was 5.8 min ± 2.3 min (range 4–18 min). No major complications occurred. Only a few locking procedures were needed to be practiced in order to obtain the required expertise with this targeting device.ConclusionAccording to our results, this device is reliable and valid whenever the correct technique is followed. It is also user friendly, exposes to lower radiation and needs less surgical time compared to relative data from the literature. However, the surgeon should always be aware of how to use the free hand technique in case of malfunctioning of the system.

Imaging in Fracture surgeries - a tool for quality assessment

“…Order of interlocking of nails with screws also dif- fer, some surgeons go for proximal locking irst and then to distal, whereas others do distal irst and then lock proximally. (Antonini et al, 2016;Caiaffa et al, 2016) In our study, all intertrochanteric fractures planned for short proximal femur nail with single headscrew and one distal locking screw were included, as of nailing for intertrochanteric fracture though technically similar but biomechanically and principle wise differs (Brin et al, 2014). In our study, we utilized only single C-arm for intra-operative luoroscopy throughout the procedure for all necessary views and steps.…”

Can the complications of distal locking be prevented with a new nail that offers a novel locking technique in the treatment of humeral shaft fractures?

“…Neurovascular and/or tendon damage, breaking of the drill, and bleeding have been reported during the distal locking stage in the treatment of humeral shaft fractures with conventional nails. [ 3 , 7 , 8 , 17 , 18 ] The distal humerus is rich in neurovascular anatomic structures; therefore, percutaneous distal locking may cause risks during conventional nailing. In their studies on cadaveric bones, Rupp et al[ 19 ] reported that the radial nerve is in direct risk in conventional nailing techniques where the distal locking is placed from lateral to medial in accordance with nail design.…”

“…In conventional nailing, the freehand technique for distal locking makes surgery difficult, while prolonging the duration and increasing radiation exposure. [ 8 , 9 , 17 ] Electromagnetic guided targeting systems have been developed to reduce these problems in conventional nails. In the literature, there are few studies reporting the results of electromagnetic systems in patients who underwent intramedullary nailing for humerus fractures.…”

“…In the literature, there are few studies reporting the results of electromagnetic systems in patients who underwent intramedullary nailing for humerus fractures. [ 8 , 17 , 18 ] Persiani et al[ 8 ] compared the electromagnetic system and freehand technique in terms of the time elapsed during the distal locking and exposure to radiation and the authors reported that the electromagnetic system significantly reduces the duration of distal locking and exposure to radiation, while causing additional cost. Antonini et al[ 17 ] reported an average distal locking time of 5.8 minutes for a single screw in their study using the electromagnetic system for humerus, femur, and tibia fractures.…”

“…[ 8 , 17 , 18 ] Persiani et al[ 8 ] compared the electromagnetic system and freehand technique in terms of the time elapsed during the distal locking and exposure to radiation and the authors reported that the electromagnetic system significantly reduces the duration of distal locking and exposure to radiation, while causing additional cost. Antonini et al[ 17 ] reported an average distal locking time of 5.8 minutes for a single screw in their study using the electromagnetic system for humerus, femur, and tibia fractures. Camarda et al[ 18 ] compared the electromagnetic system with freehand technique for distal locking and they reported no significant difference between the two techniques in terms of total duration of surgery.…”