Distal Locking of Intramedullary Nailing: Current Technology to Improve Accuracy,
Radiation Exposure, and Operative Time
Gary Ulrich1* and David Rich2
1Department of Orthopedic Surgery, University of Kentucky College of Medicine,
Lexington, KY, USA
2Eclipse Orthopaedics LLC, Warsaw, IN, USA
*Corresponding Author: Gary Ulrich, Department of Orthopedic Surgery,
University of Kentucky College of Medicine, Lexington, KY, USA.
July 18, 2023; Published: July 29, 2023
Distal locking during intramedullary nailing of long bone fractures remains a challenging part of this procedure, especially for novice surgeons. The conventional freehand method has been the mainstay for the placement of distal locking screws. However, the conventional freehand method possesses the disadvantages of additional radiation exposure as well as increased operative time and inaccuracy for the inexperienced surgeon. Numerous technology adjuncts have been developed to improve upon the distal locking technique during the intramedullary nailing of long bone fractures. In this review, we discuss the common technology that has been designed to facilitate the placement of distal locking screws, which include electromagnetic navigation systems, computer-assisted/robotic systems, laser guiding systems, the flag and grid technique, proximally mounted targeting devices, and self-locking nailing systems.
Conclusion: Calcaneal Fractures; Minimally Invasive; Sinus Tarsi Approach.
Keywords: Intramedullary Nailing; Distal Locking Screws; Accuracy; Radiation Exposure; Operative Time
- Han B., et al. “Comparison of free-hand fluoroscopic guidance and electromagnetic navigation in distal locking of femoral intramedullary nails”. Medicine29 (2017).
- Wang Yinsheng., et al. “Comparison of free-hand fluoroscopic guidance and electromagnetic navigation in distal locking of tibia intramedullary nails”. Medicine27 (2018).
- Grimwood Darren and Jane Harvey-Lloyd. "Reducing intraoperative duration and ionising radiation exposure during the insertion of distal locking screws of intramedullary nails: a small-scale study comparing the current fluoroscopic method against radiation-free, electromagnetic navigation”. European Journal of Orthopaedic Surgery and Traumatology26 (2016): 867-876.
- Zhu Yanbin., et al. “Meta-analysis suggests that the electromagnetic technique is better than the free-hand method for the distal locking during intramedullary nailing procedures”. International Orthopaedics41 (2017): 1041-1048.
- Allard Arthur., et al. “Evaluation of the accuracy of the Sureshot® electromagnetic targeting system in distal locking of long-nailed humeral diaphyseal fractures”. Orthopaedics and Traumatology: Surgery and Research2 (2021): 102785.
- Yaniv Ziv and Leo Joskowicz. "Precise robot-assisted guide positioning for distal locking of intramedullary nails”. IEEE Transactions on Medical Imaging5 (2005): 624-635.
- Gao Hua., et al. “A new accurate, simple and less radiation exposure device for distal locking of femoral intramedullary nails”. International Journal of General Medicine (2021): 4145-4153.
- Yiannakopoulos Christos K., et al. “Distal intramedullary nail interlocking: the flag and grid technique”. Journal of Orthopaedic Trauma6 (2005): 410-414.
- Anastopoulos George., et al. “Distal locking of tibial nails: a new device to reduce radiation exposure”. Clinical Orthopaedics and Related Research466 (2008): 216-220.
- Zirkle Lewis G., and Faseeh Shahab. "Interlocked intramedullary nail without fluoroscopy”. Orthopedic Clinics1 (2016): 57-66.
- Ikem Innocent C., et al. “Achieving interlocking nails without using an image intensifier”. International Orthopaedics31 (2007): 487-490.
- Lepore Luciano, Stefano Lepore and Nicola Maffulli. "Intramedullary nailing of the femur with an inflatable self-locking nail: comparison with locked nailing”. Journal of Orthopaedic Science8 (2003): 796-801.