Comparison of free-hand fluoroscopic guidance and electromagnetic navigation in distal locking of femoral intramedullary nails

Abstract

Background:Although the method has been used widely, one of the greatest challenges for intramedullary nailing is to position the distal locking screw. A new technology, the electromagnetic navigation system, is a radiation-free way to locate the position of the drill bit and provide 3-dimensional real-time feedback of location and orientation of the drill bit relative to the locking holes. The purpose of our study was to evaluate the reliability and efficiency of the free-hand technique compared to the new electromagnetic navigation system.Methods:Fifty-four patients with femoral fracture who needed treatment with intramedullary nails were divided into 2 groups. One group including 26 patients underwent distal locking using the standard free-hand method, whereas the electromagnetic navigation system was used with the other 29 patients. Intraoperative fluoroscopy exposure times, screw insertion times, and healing times were recorded; these parameters were used for comparison between the 2 groups.Results:There were 17 males and 9 females who had femoral intramedullary nails using the free-hand technique, whereas 21 males and 8 females received intramedullary nails using the electromagnetic navigation system. The mean time of distal locking was 19.5 ± 6.0 minutes in the free-hand (FH) group, whereas the time was 6.1 ± 1.4 minutes in the electromagnetic (ET) group. The exposure time for the FH group was 26.8 ± 13.3 seconds and 2.2 ± 1.1 seconds for the ET group. Healing time proved to be comparable in the FH and ET groups (16.4 ± 3.7 weeks vs 15.1 ± 2.8 weeks).Conclusion:Under the premise of achieving the same effect, the electromagnetic navigation system has the advantage of less distal locking time and less radiation dose.

Does electromagnetic guidance system superior to free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study

“…In long bone fractures of the lower extremities, there are studies indicating that the distal locking method with electromagnetic guidance (EMG) system does not make a difference despite studies reporting that it reduces operative time and radiation exposure. [4][5][6]12,13] Studies on distal free hand and magnetic locking intramedullary nails have reported different results concerning operative time, duration of fluoroscopy and radiation exposure. Kirousis et al [18] reported that the mean fluoroscopy duration was 71 seconds in whole intramedullary nailing procedure with free hand technique.…”

“…As discussed above, current literature suggests that the EM technique is a better alternative for distal locking in the intramedullary nailing procedure. [1,12,13] However, devices accompanying the EMG-assisted distal screwing systems have the disadvantages of requiring technical skills, a long learning curve, and being uneconomic and unpractical. [2,3] The results of our study showed no difference between the EMG and FHM in tibia fractures.…”

“…There are studies suggesting that DLS reduces operation duration radiation exposure despite studies reporting that it does not make a difference. [4,12] The current literature suggest that the EMGS is a better alternative for distal locking in the IMN procedure. [1,12,13] However, IMNs with EMGSs have the disadvantages of requiring technical skills, having a long learning curve and being uneconomical and unpractical.…”

“…[4,12] The current literature suggest that the EMGS is a better alternative for distal locking in the IMN procedure. [1,12,13] However, IMNs with EMGSs have the disadvantages of requiring technical skills, having a long learning curve and being uneconomical and unpractical. [2,3] On the other hand, inexpensive and simple FHTs, which reduce radiation exposure in distal screwing, have been described.…”

“…Although there are similar comparative studies, [5,8,12,13] the free hand technique described in the studies is different. On the other hand, the study of Aldemir et al [2] which we used the free hand technique's, is not comparative and it was written in Turkish.…”