Achieving distal locking without an image intensifier

The tibia is commonly fractured bone frequently caused by high energy trauma leading to the complications and major disabilities. Different types of intramedullary nails have been employed by surgeons over 500 years. Today, the intramedullary interlocking tibial nailing is the leading modality of treatment because of its biomechanical advantage over the other modalities. This procedure is done in the advanced centers under the C-arm image intensifier. Yet, there is no facility of C- arm image intensifier in the operation theatre at the tertiary level public hospitals in Nepal. Most of the peripheral hospitals do not have portable X- ray facility. The purpose of this study was to study the success rate of distal locking in the intramedullary nailing of tibial shaft fractures with the aid of distal aiming device (DAD). The distal locking were done in 65 tibial shaft fractures. In this technique the distal hole was directly visualized after proper drilling. All the distal locking could be done without image intensifier. So this technique can be useful where the imaging facilities are not available and even in the advanced centers to avoid radiation hazards.