Nail over nail technique for distal locking of femoral intramedullary nails

Abstract

The free hand technique remains the most popular method for distal locking; however, radiation exposure is a major concern. In an endeavour to overcome this concern, distal locking with the nail over nail technique is evaluated. Seventy patients with femoral diaphyseal fractures treated by intramedullary nailing were divided in two groups for distal locking: either using the free hand technique (group I) or with the nail over nail technique (group II). The average number of images taken to achieve nail insertion without locking, for distal locking, and for the complete procedure in group I was 25.8, 24.2, and 50.08, respectively, compared with 24.8, 4.1, and 28.9, respectively, in group II (statistically extremely significant decrease in radiation). The nail over nail technique appears to be a reliable solution for decreasing radiation exposure during closed femoral intramedullary nailing. However, over-reaming of 1.5 mm is the key to the success of the technique.

Next generation distal locking for intramedullary nails using an electromagnetic X-ray-radiation-free real-time navigation system

“…5 Therefore, every effort must be made to minimize radiation exposure. 5,17 The average radiation time to achieve distal locking with the free-hand technique in our study was within the range reported in the literature. 11,17,21 As no problems occurred using the electromagnetic guidance system, no fluoroscopy was used during the distal locking procedure.…”

“…5,17 The average radiation time to achieve distal locking with the free-hand technique in our study was within the range reported in the literature. 11,17,21 As no problems occurred using the electromagnetic guidance system, no fluoroscopy was used during the distal locking procedure. Standard two-plane fluoroscopic confirmation of correct screw positioning was obtained for both procedures once distal locking was accomplished.…”

“…17,20 Moreover, long-term effects of radiation exposure are unknown. 5 Therefore, every effort must be made to minimize radiation exposure.…”

“…17 Beside real-time navigation of the drilling process, the electromagnetic guidance system used in this study provides the opportunity for real-time navigation of screw insertion as well. In our study, screw insertion times, using either the electromagnetic guiding option or the standard method by palpating the drill hole with the screw tip, did not show significant differences.…”

Distal unlocked proximal femoral intramedullary nailing for intertrochanteric femur fractures

“…At present, the PFN is considered to be a good minimally invasive implant for treating proximal femoral fractures, especially where closed reduction is possible. However, neck screw cut-outs, Z-effect with migration of the pin into the joint, reversed Z-effect, femoral fracture at the nail tip or at the distal screw insertion site, thigh pain due to iliotibial tract irritation or cortical hypertrophy and difficulty in distal screw insertion are among the possible complications that can be encountered [2,9].…”