Free-hand distal locking of intramedullary nails: How to quickly achieve perfect circles without specific...

Intramedullary locked nails are mainly used for the fixation of mid-shaft fractures in the long bones. But inserting the distal locking screws by the free-hand technique may require high exposure to radiation. Our method achieves perfect circles on radiographs on the first attempt for lower limb fractures without any specific instrumentation.

We applied a geometric principle in which two lines perpendicular to another line are parallel to each other. Proximal locking, whether it is done or not, serves as a guide for the first perpendicular line to the nail. The fluoroscopy unit is aligned along the drill sleeve or the screwdriver left in place to achieve perfect circles on the first attempt.

This technique is simple, reliable, and reproducible. It does not require any specific instrumentation, allows the surgeon to choose any manufacturer's nail and reduces the operating room staff's exposure to radiation.