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Achieving distal locking without an image intensifier.

S K Giri1

  • 1Department of Orthopaedics, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal. skgiri@healthnet.org.np

Nepal Medical College Journal : NMCJ
|February 27, 2008
PubMed
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This study shows that a distal aiming device (DAD) allows successful distal locking in tibial shaft fractures without C-arm imaging. This technique is valuable for resource-limited settings and reduces radiation exposure in advanced centers.

Area of Science:

  • Orthopedic surgery
  • Trauma care
  • Medical device innovation

Background:

  • Tibia fractures are common, often resulting from high-energy trauma, leading to significant disability.
  • Intramedullary interlocking tibial nailing is the preferred treatment due to its biomechanical advantages.
  • Lack of C-arm image intensifiers in many public hospitals, particularly in Nepal, hinders optimal surgical outcomes.

Purpose of the Study:

  • To evaluate the success rate of distal locking in tibial shaft fractures using a distal aiming device (DAD).
  • To assess the feasibility of performing intramedullary nailing without image intensification in resource-limited environments.

Main Methods:

  • A prospective study involving 65 tibial shaft fractures treated with intramedullary nailing.
  • Utilized a distal aiming device (DAD) for direct visualization and drilling of the distal locking hole.

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  • No intraoperative image intensifier (C-arm) was used during the distal locking procedure.

    • Main Results:

    • Successful distal locking was achieved in all 65 cases using the DAD.
    • The technique allowed for direct visualization and accurate placement of distal screws.
    • No complications related to the distal locking procedure were reported.

    Conclusions:

    • The distal aiming device (DAD) is an effective tool for achieving successful distal locking in tibial shaft fractures.
    • This method provides a viable alternative for intramedullary nailing in settings lacking advanced imaging facilities.
    • The DAD technique can also be beneficial in advanced centers to minimize radiation exposure for patients and staff.