The insertion of distal femoral interlocking screws: freehand anteroposterior view versus lateral view technique | [Journal of Postgraduate Medical Institute • 2024]

Author(s):

1. Naeemullah: Department of Orthopaedics, Lady Reading Hospital Peshawar,,Pakistan

2. Faaiz Ali Shah: Department of Orthopaedics, Lady Reading Hospital Peshawar,,Pakistan

3. Mian Javed Iqbal: Department of Orthopaedics, Lady Reading Hospital Peshawar,,Pakistan

4. Mian Amjad Ali: Department of Orthopaedics, Lady Reading Hospital Peshawar,,Pakistan

Abstract:

Objective: To compare the freehand anteroposterior view technique for the insertion of distal femoral interlocking Faaiz Ali Shah screws with the lateral view technique in term of success rate, time required and the number of fluoroscopic shots. Department of Orthopaedics, Lady Reading Hospital Peshawar Pakistan 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. 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 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.

Page(s): 70-77

DOI: 10.54079/jpmi.38.1.3317

Published: Journal: Journal of Postgraduate Medical Institute, Volume: 38, Issue: 1, Year: 2024

Keywords:

Freehand technique , Radiation , Intramedullary nail , Fluoroscopy , Carm , Distal Interlocking

References:

[1] Brumback RJ. .1996 .The rationales of interlocking nailing of the femur, tibia, and humerus. Clin Orthop Relat Res, 10 : 00003086-320.

[2] Winquist RA. Locked Femoral,Nailing RA. Locked Femoral .1993 .. J Am Acad Orthop Surg, 10(2) : 00124635-105.

[3] Whatling GM,Nokes LD .2005 .Literature review of current techniques for the insertion of distal screws into intramedullary locking nails. Injury, 09(2) : 109-19.

[4] Maqungo S,Horn A,Bernstein B,Keel M,Roche S M .2014 .Distal interlocking screw placement in the femur: free-hand versus electromagnetic assisted technique (sureshot). J Orthop Trauma, 10(12) : e281-3.

[5] Patra SK,Patro BP,Samal S,Sahu MC,Mohanty BB .2016 .Distal locking of femoral nails: A prospective comparative study of two different fluoroscopy assisted techniques. Int Sug J, 3(1) : 23-240.

[6] Coetzee JC .1992 .Exposure of surgeons-in-training to radiation during intramedullary fixation of femoral shaft fractures. S Afr Med J, 81(6) : 312-4.

[7] Barry TP .1984 .Radiation exposure to an orthopedic surgeon. Clin Orthop Relat Res, : 160-4.

[8] Singer G .2005 .Occupational radiation exposure to the surgeon. J Am Acad Orthop Surg, 10(1) : 00124635-76.

[9] Tyropoulos S,Garnavos C. .2001 .A new distal targeting device for closed interlocking nailing. Injury, 1383(01) : 00021-3.

[10] Kelley SS,Bonar S,Hussamy OD,Morrison JA OD .1995 .A simple technique for insertion of distal screws into interlocking nails. J Orthop Trauma, 10(3) : 00005131-30.

[11] Holistien S,Ruth JT .1996 .Electromagnetic distal targeting for the placement of transverse interlocking screws. Osteo Int, 3 : 196-203.

[12] Krettek C,Mannss J,Konemann B,Miclau T,Schandelmaier P,Tscherne H. .1997 .The deformation of small diameter solid tibial nails with unreamed intramedullary insertion. J Biomech, 9290(96) : 00160-1.

[13] Ostrum RF .2015 .Perceptions and realities for distal freehand interlocking of intramedullary nails. Adv Orthop, 10 : 834582.

[14] Zhang K,Ma Y,Wu j,Shi Q,Barchi LC,Scarci M .2023 .The SUPER reporting guideline suggested for reporting of surgical technique. HepatoBiliary Surg Nutr, 10(4) : 534-44.

[15] Rohilla R,Singh R,Magu N,Devgun A,Siwach R,Gulia A .2009 .Nail over nail technique for distal locking of femoral intramedullary nails. Int Orthop, 10(4) : 1107-12.

[16] Stevens JM,Shiels S,Chesser T .2021 .Technique for Guiding Distal Locking Screws into Intramedullary Nails. Tech Orthop, 10 : 188-9.

[17] Sanders R,Koval KJ,DiPasquale T,Schmelling G,Stenzler S,Ross E. .1993 .Exposure of the orthopaedic surgeon to radiation. J Bone Joint Surg Am, 10(3) : 00004623-30.

[18] Granhed HP. .1998 .A new technique of distal screw insertion for locked nailing. Acta Orthopaedica Scandinavica, 69 : 320-321.

[19] Vatkar A,Kale S,Chaudhari P,Dhar S P .2017 .By-passing the perfect circle method of femoral distal interlocking Screw Insertion (DISI) in Interlocking nailing - a technical note and retrospective study. J Clin Orthopaedics. Jan-June, 435(1) : 6993-12.

[20] Chan DS,Burris RB,Erdogan M,Sagi H.,Trauma J Orthop .2013 .The Insertion of Intramedullary Nail Locking Screws Without Fluoroscopy: A Faster and Safer Technique. , 10(7) : 363-6.

[21] Lal H,Vidyarthi K,Mittal D. .2011 .A foolproof technique for lock-check and distal locking in interlock nailing. J Clin Orthop Trauma, 5662(11) : 60033-7.

[22] Finelli CA,Ziran BH,Torini AP,Fernandes HJ .2014 .Interlocking screws placed with freehand technique and uni-planar image intensification: the "dip-stick" technique. Injury, 1383(14) : 70016-6.

[23] Baris A .2022 .An Effective Method for Intramedullary Fixation of Long Bone Fractures Reducing the Operative Duration and Flouroscopy Time: Guide Wire Assisted Nail Locking. Eurasian J Med, 44901(1) : 38-44.

[24] MacMillan M,GRoss RH M .1988 .A simplified technique of distal femoral screw insertion for the Grosse-Kempf interlocking nail. Clin Orthop Relat Res, 226 : 252-9.

[25] Stevens JM,Shiels S,Chesser T .2021 .Technique for Guiding Distal Locking Screws into Intramedullary Nails. Tech Orthop, 10 : 188-9.

[26] Hsu WE,Yu CH,Chang CJ,Wu HK,Yu TH,Tseng CS TH .2018 .C-Arm Image-Based Surgical Path Planning Method for Distal Locking of Intramedullary Nails. Appl Bionics Biomech, 10 : 4530386.

[27] Gao H,Liu Z,Bai X,Xu G,Chen W .2022 .Comparison of freehand technique and a novel laser guiding navigation in distal locking of femoral intramedullary nails: a randomized controlled trial. BMC Surg, 10 : 363.

[28] Saket R,Naik AK,Mishra PP,Pratap R,Sahoo M. .2023 .Mechanical aiming device for Distal Locking in femur nail-an undeveloped part of femur nail system. J Orth Clin Res, 1(2) : 010-86.

[29] Pardiwala D,Prabhu V,Dudhniwala G,Katre R .2001 .The AO distal locking aiming device: an evaluation of efficacy and learning curve. Injury, 1383(01) : 00100-0.

[30] Yiannakopoulos CK,Kanellopoulos AD,Apostolou C,Antonoqiannakis E,Korres DS .2005 .Distal intramedullary nail interlocking: the flag and grid technique. J OrthopTrauma, 10(6) : 407-11.

[31] Pastor T,Pastor T,Kastner P,Souleiman F,Knobe M,Gueorguiev B .2022 .Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking. Medicina, 58(6) : 773.

[32] . .. DOI: 10, : .

Citations

Citations are not available for this document.

Citations

Downloads

Views