THE INSERTION OF DISTAL FEMORAL INTERLOCKING SCREWS: FREHAND ANTEROPOSTERIOR VIEW VERSUS LATERAL VIES TECHNIQUE
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Abstract
Objective:
To compare the freehand anteroposterior view technique for the insertion of distal femoral interlocking screws with the lateral view technique in term of success rate, time required and the number of fluoroscopic shots.
Methodology:
This Quasi-experimental study was conducted in Orthopedic division Lady Reading Hospital Peshawar from 4th October 2022 to 05th August 2023. In group “A” both the distal locking screws of the interlocking nail femur were inserted under C-arm using freehand anteroposterior view technique while in group “B” conventional freehand lateral view technique was used. The success rate of distal screw insertion was determined using Rohilla and Singh criteria. The time taken for screw insertion and number of C-arm shots was compared in both groups.
Results:
The total number of patients were 186. Each group A and B had 93 patients each. No failure of screw insertion was noted in group A while in group B failure was noted for distal screws in 23 (24.73%) and for proximal screws in 15 (16.12%) patients (p<0.05). In group A the average time required for the insertion of distal interlocking screw was 6.4 ± 1.3 minutes in group A and 16.9 ± 1.5 minutes in group B (p<0.05).The average number of C-arm shots were 5.4 ± 1.7 for inserting distal interlocking screws in group A while 15 ± 1.2 shots were used for the insertion of distal interlocking screw in group B (p<0.05).
Conclusion:
We achieved successful insertion of the distal femoral interlocking screws with freehand technique in anteroposterior view in majority of our patients. The technique took less time and less radiation exposure than conventional lateral view technique.
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References
Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg Am. 1985 Jun;67(5):709-20.
Brumback RJ. The rationales of interlocking nailing of the femur, tibia, and humerus. Clin Orthop Relat Res. 1996 Mar;(324):292-320. doi: 10.1097/00003086-199603000-00036.
Winquist RA. Locked Femoral Nailing. J Am Acad Orthop Surg. 1993 Nov;1(2):95-105. doi: 10.5435/00124635-199311000-00004.
Whatling GM, Nokes LD. Literature review of current techniques for the insertion of distal screws into intramedullary locking nails. Injury. 2006 Feb;37(2):109-19. doi: 10.1016/j.injury.2005.09.009.
Maqungo S, Horn A, Bernstein B, Keel M, Roche S. Distal interlocking screw placement in the femur: free-hand versus electromagnetic assisted technique (sureshot). J Orthop Trauma. 2014 Dec;28(12):e281-3. doi: 10.1097/BOT.0000000000000125.
Patra SK, Patro BP, Samal S, Sahu MC, Mohanty BB. Distal locking of femoral nails: A prospective comparative study of two different fluoroscopy assisted techniques. Int Sug J. 2016;3:23-240.
Coetzee JC, van der Merwe EJ. Exposure of surgeons-in-training to radiation during intramedullary fixation of femoral shaft fractures. S Afr Med J. 1992 Mar 21;81(6):312-4.
Barry TP. Radiation exposure to an orthopedic surgeon. Clin Orthop Relat Res. 1984 Jan-Feb;(182):160-4.
Singer G. Occupational radiation exposure to the surgeon. J Am Acad Orthop Surg. 2005 Jan-Feb;13(1):69-76. doi: 10.5435/00124635-200501000-00009.
Tyropoulos S, Garnavos C. A new distal targeting device for closed interlocking nailing. Injury. 2001 Nov;32(9):732-5. doi: 10.1016/s0020-1383(01)00021-3
Kelley SS, Bonar S, Hussamy OD, Morrison JA. A simple technique for insertion of distal screws into interlocking nails. J Orthop Trauma. 1995 Jun;9(3):227-30. doi: 10.1097/00005131-199506000-00008.
Holistien S, Ruth JT: Electromagnetic distal targeting for the placement of transverse interlocking screws. Osteo Int 1996; 3:196-203.
Krettek C, Mannss J, Könemann B, Miclau T, Schandelmaier P, Tscherne H. The deformation of small diameter solid tibial nails with unreamed intramedullary insertion. J Biomech. 1997 Apr;30(4):391-4. doi: 10.1016/s0021-9290(96)00160-1.
Ostrum RF. Perceptions and realities for distal freehand interlocking of intramedullary nails. Adv Orthop. 2015;2015:834582. doi: 10.1155/2015/834582.
Zhang K, Ma Y, Wu j, Shi Q, Barchi LC, Scarci M, et al. The SUPER reporting guideline suggested for reporting of surgical technique. HepatoBiliary Surg Nutr 2023;12(4):534-544 | https://dx.doi.org/10.21037/hbsn-22-509
Rohilla R, Singh R, Magu N, Devgun A, Siwach R, Gulia A. Nail over nail technique for distal locking of femoral intramedullary nails. Int Orthop. 2009 Aug;33(4):1107-12. doi: 10.1007/s00264-008-0579-y.
Stevens JM, Shiels S, Chesser T. Technique for Guiding Distal Locking Screws into Intramedullary Nails. Tech Orthop 2021;36: 188–189.
Sanders R, Koval KJ, DiPasquale T, Schmelling G, Stenzler S, Ross E. Exposure of the orthopaedic surgeon to radiation. J Bone Joint Surg Am. 1993 Mar;75(3):326-30. doi: 10.2106/00004623-199303000-00003.
Granhed HP. A new technique of distal screw insertion for locked nailing, Acta Orthopaedica Scandinavica 1998; 69:3, 320-321, DOI: 10.3109/17453679809000939.
Vatkar A, Kale S, Chaudhari P, Dhar S. By-passing the perfect circle method of femoral distal interlocking Screw Insertion (DISI) in Interlocking nailing – a technical note and retrospective study. Journal of Clinical Orthopaedics Jan-June 2018; 3(1):10-12.
Chan DS, Burris RB, Erdogan M, Sagi, H. The Insertion of Intramedullary Nail Locking Screws Without Fluoroscopy: A Faster and Safer Technique. J Orthop Trauma 27(7):363-366, July 2013. DOI: 10.1097/BOT.0b013e3182828e10.
Lal H, Vidyarthi K,Mittal D.A foolproof technique for lock-check and distal locking in interlock nailing. JCOT 2011; 2 (1):23-28.Doi https://doi.org/10.1016/S0976-5662(11)60033-7:
Gao H , Liu Z, Bai X, Xu G ,Chen W, Ma Ji, et al. Comparison of freehand technique and a novel laser guiding navigation in distal locking of femoral intramedullary nails: a randomized controlled trial. BMC Surg 22, 363 (2022). https://doi.org/10.1186/s12893-022-01815-5.
MacMillan M, GRoss RH. A simplified technique of distal femoral screw insertion for the Grosse-Kempf interlocking nail. Clin Orthop Relat Res. 1988 Jan 1;226:252-9.
Stevens JM, Shiels S, Chesser T. Technique for Guiding Distal Locking Screws into Intramedullary Nails. Tech Orthop 2021;36: 188–189.
Hsu WE, Yu CH, Chang CJ, Wu HK, Yu TH, Tseng CS. C-Arm Image-Based Surgical Path Planning Method for Distal Locking of Intramedullary Nails. Appl Bionics Biomech. 2018 May 23;2018:4530386. doi: 10.1155/2018/4530386.
Pardiwala D, Prabhu V, Dudhniwala G, Katre R. The AO distal locking aiming device: an evaluation of efficacy and learning curve. Injury. 2001;32:713–718. doi: 10.1016/S0020-1383(01)00100-0.
Yiannakopoulos CK, Kanellopoulos AD, Apostolou C, Antonoqiannakis E, Korres DS. Distal intramedullary nail interlocking: the flag and grid technique. J OrthopTrauma. 2005;19(6):407–411.doi: 10.1097/bot.0000151815.94798.64.
Pastor T, Pastor T, Kastner P, Souleiman F, Knobe M, Gueorguiev B, et al. Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking. Medicina 2022; 58:773. https://doi.org/10.3390/medicina 58060773