Achieving interlocking nails without using an image intensifier

Abstract

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.

Treatment With the SIGN Nail in Closed Diaphyseal Femur Fractures Results in Acceptable Radiographic Alignment

“…SIGN currently has greater than 250 sites in more than 50 countries where SIGN nails have become a mainstay of treatment used by local surgeons [14]. The SIGN nails have been approved by the FDA and have shown good clinical results in small clinical series [7,12,13]. The SIGN standard nail was designed and began use in 1999 and is a solid stainless steel nail with a 9°p roximal bend and 1.5°distal bend, offered in 8 mm to 12 mm diameters and 280 mm to 420 mm lengths [14].…”

“…It is a utilitarian design and is used in the femur, tibia, and humerus in antegrade and retrograde approaches. Using a specially designed proximal jig and extended aiming arm, the nail is designed to be interlocked proximally and distally without fluoroscopic imaging [7,14]. The nail is designed and manufactured in-house by SIGN in Richland, Washington, and the standard nail has now been joined by several other implants including the fin nail (which uses distal flanges in lieu of distal interlocked screws), a pediatric nail, and hip nails.…”

The Role of SIGN in the Development of a Global Orthopaedic Trauma Database

“…In view of these low figures and the probability that followup cases in the database are biased toward difficult and unexpected outcomes, we suggest the data in the SIGN database itself cannot be used for outcome studies. It is, however, a source of cases that were used for followup studies [15,32,33].…”

“…The institutions are resupplied with implants after 20 cases have been submitted to the database. The database has also been used extensively for collecting cases for studies on the union rate and complications of this treatment method [15,32,33]; many other studies have been presented to the annual SIGN conferences or in the country of origin. The December 2009 issue of Techniques in Orthopaedics [44] is devoted to reports about the SIGN surgical system [34].…”

Interlocking nailing without imaging: the challenges of locating distal slots and how to overcome them in SIGN intramedullary nailing

“…This avoids intraoperative exposure to ionising radiation from image intensifiers. These image intensifiers are expensive and not readily available in many countries and centres, thus making SIGN nailing ideal for most resource-poor countries of the world [1]. Over 4,500 SIGN operations in 150 programmes spread over 51 countries in Africa, Asia, Europe, North America and South America are using this rapidly spreading SIGN interlocking nailing system for the treatment of humerus, tibia and femur fractures [4,5].…”