A new mechanical aiming device for the placement of distal interlocking screws in femoral nails

Krettek, Christian; Könemann, B.; Miclau, Theodore; Kölbli, R.; Machreich, T.; Kromm, Alexander; Tscherne, H.

doi:10.1007/s004020050215

Cited by 50 publications

(22 citation statements)

References 22 publications

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“…However, its main drawbacks are cost and the need for a reliable intraoperative image intensifier support [5,6,22,25]. There are now nails that can be locked with the aid of external jigs [1,3,12,16,22,24,25]. In this study, 100% of the fractures were fixed without the use of an image intensifier with the satisfactory placement of nails and screws in all cases.…”

Section: Discussionmentioning

confidence: 99%

“…However, the exclusion of an image intensifier automatically eliminates the harmful effect of an increased dose of radiation to both the orthopaedic surgeon and the patient [10,16,24]. It has the added advantage of reduced cost to the patient whilst, at the same time, ensuring high-quality fracture care comparable to any in the developed countries.…”

Section: Discussionmentioning

confidence: 99%

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Achieving interlocking nails without using an image intensifier

Ikem

Ogunlusi

Ine

2006

International Orthopaedics (SICO

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Interlocking nails are commonly performed using an image intensifier. These are expensive and are not readily available in most resource-poor countries of the world. The aim of this study was to achieve interlocking nailing without the use of an image intensifier. This is a prospective descriptive analysis of 40 consecutive cases seen with shaft fractures of the humerus, femur, and tibia. Fracture fixation was done using Surgical Implant Generation Network (SIGN) nails. Forty limbs in 34 patients were studied. There were 12 females and 22 males, giving a ratio of 1:2. The mean age (years) was 35.75± 13.16 and the range was 17-70 years. The studied bones were: humerus 10%, femur 65%, and tibia 25%. The fracture lines were: transverse 40%, oblique 15%, and communited 45%. Fracture grades were: closed 90%, grade I, 5%, grade II, 2.5%, and grade IIIA, 2.5%. Surgical approaches were: antegrade 62.5% and retrograde 37.5%. Indications for fixation were: recent fracture 92.5%, non-union 5%, and malunion 3%. Methods of reductions were: open 85% and closed 15%. The mean follow-up period (years) was 1.50±0.78. The union time averaged 3 months. Complication was mainly screw loosening due to severe osteoporoses in one case. It is, therefore, concluded that, with the aid of external jigs and slot finders, interlocking can be achieved without an image intensifier.Résumé Les clous verrouillés sont d'utilisation commode mais demande une imagerie dans leur utilisation. Cette imagerie est chère et ne peut être réalisée de façon valable dans les pays pauvres. Le but de cette étude est de montrer que le verrouillage des clous peut se faire sans l'utilisation d'une imagerie. Il s'agit d'une étude prospective de 40 cas de fracture de la diaphyse humérale, fémorale ou tibiale, la fixation de ces fractures étant réalisée par un clou de type SIGN. 40 membres chez 34 patients ont été étudiés, 12 femmes, 22 hommes (ratio de 12). L'âge moyen a été de 35,75±13,16 s'échelonnant de 17 à 70 ans. Les fractures affectaient l'humérus dans 10% des cas, le fémur dans 65% des cas et le tibia dans 25% des cas. La fracture était transverse dans 40% des cas, oblique dans 15% et communitive dans 45% des cas. Il s'agissait d'une fracture fermée dans 9 cas sur 10. Lorsqu'elle était ouverte, de grade I dans 5%, de grade II dans 2,5% et de grade IIIA dans 2,5%. L'approche chirurgicale a été antérieure dans 62,5% des cas et postérieure dans 37,5% des cas. Il s'agissait d'enclouage pour fixer une fracture fraîche dans 92,5% des cas, après pseudarthrose dans 5% des cas et cal vicieux dans 3% des cas. La réduction a été réalisée par voie sanglante dans 85% des cas, à foyer fermé dans 5% des cas. Le suivi moyen a été de 1,50±0,78, la consolidation a été obtenue en moyenne en 3 mois. Une seule complication avec mobilisation d'une vis après une ostéoporose sévère a été observée dans un seul cas. Nous pouvons conclure qu'il est possible, grâce à la méthode que nous décrivons de verrouiller un clou sans imagerie.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Achieving interlocking nails without using an image intensifier

Ikem

Ogunlusi

Ine

2006

International Orthopaedics (SICO

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“…In the literature (6,14), the exposure time is given as 66-414 s. Moreover, freehand operation is less stable and demands much experience. Mechanical positioning (1,4,5,12) adopts specifically designed localizing devices to indicate the distal locking path. The C-arm is not needed and the instrument is simple to operate.…”

Section: Introductionmentioning

confidence: 99%

A biplanar robot navigation system for the distal locking of intramedullary nails

Luan

Wang

et al. 2009

Robotics Computer Surgery

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“…These techniques include laser [5] or computer guidance [12] and the use of long proximally mounted targeting devices [10,11,13,15]. The Surgical Implant Generation Network (SIGN) (Richland, WA, USA) nail has a proven record of success in treating femoral shaft fractures without intraoperative fluoroscopy [15].…”

Section: Introductionmentioning

confidence: 99%

Surgical Technique: Static Intramedullary Nailing of the Femur and Tibia Without Intraoperative Fluoroscopy

White

Sorkin

Konopka

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background On a recent mission directed at definitive care for victims of the Haitian earthquake, the orthopaedic team developed a technique for freehand distal locking of femoral and tibial nails without intraoperative fluoroscopy or proximally mounted targeting jigs. Description of TechniqueAfter performing open antegrade or retrograde nailing by standard techniques, the freehand lock must be obtained before doing standard outrigger locking. This allows the surgeon to control the nail and deliver the locking hole in the nail to a unicortical drill hole in the femur. Before nail insertion, the distance of the desired locking hole is measured from the outrigger in a standard way such that it can be reproduced after the nail is inserted. Through a unicortical drill hole, the nail is palpated with the tip of a Kirschner wire and systematic maneuvers allow the Kirschner wire to palpate and fall into the locking hole. The Kirschner wire is tapped across the second cortex before drilling. The screw is inserted, and the ball-tipped insertion guidewire is placed back into the nail to palpate the crossing screw confirming position. Patients and Methods We treated 16 patients with 18 long bone fractures using the described technique. We assessed patients clinically and radiographically immediately postoperatively. Results A total of 19 blind freehand interlocks were attempted, and 17 were successful as assessed by direct intraoperative observations and by postoperative radiographs. Conclusions We describe a simple technique for performing static locked intramedullary nailing of the femur and tibia without fluoroscopy. This technique was successful in most cases and is intended for use with any nailing system only when fluoroscopy or specialized systems for nailing without fluoroscopy are not available.

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A new mechanical aiming device for the placement of distal interlocking screws in femoral nails

Cited by 50 publications

References 22 publications

Achieving interlocking nails without using an image intensifier

Achieving interlocking nails without using an image intensifier

A biplanar robot navigation system for the distal locking of intramedullary nails

Surgical Technique: Static Intramedullary Nailing of the Femur and Tibia Without Intraoperative Fluoroscopy

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