The effectiveness of the external distal aiming device in intramedullary fixation of tibial shaft fractures

Introduction Intramedullary nailing has become a popular and effective procedure for the treatment of most fractures of the tibial diaphysis. However, distal interlocking screw placement under fluoroscopic control is responsible for the majority of the radiation exposure and a significant loss of surgical time in the entire nailing procedure. To limit fluoroscopy use, during distal interlocking screw placement, Orthofix (R) has developed a distal targeting device which compensates for the inevitable deformation of the nail in the sagittal plane during its insertion. This prospective clinical study evaluates the efficacy of this distal targeting device for distal locking. Materials and methods One hundred and fifteen fresh tibial fractures in the same number of patients with a mean age of 37.5 years (17-85 years) were treated with operative stabilization using the Orthofix tibial nailing system. Results The mean duration of the operation was 38 min (20-55 min). A mean of four intra-operative plain X-rays (2-6 X-rays) were used in 103 cases to confirm guide wire placement, final nail insertion and accuracy of screws placement. The mean duration of the use of the image intensifier utilized in the remaining 12 fractures was 5 s (3-8 s). The distal targeting device failed in 12 (5.2%) distal locking screws. Conclusion This study demonstrates that distal locking can be performed easily and successfully with minimal exposure to radiation, once the surgeon develops a reasonable experience with the use of this distal targeting device.