Magnetic Equipped Wire Device-for Closed Interlocking Intramedullary Femoral Nailing: A Method That Avoids Exposure to Ionizing Radiations

Document Type : Original Article

Authors

1 Orthopedic Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, IR Iran

2 Department of Research and Education, Razavi Hospital, Mashhad, IR Iran

10.30483/rijm.2014.118370

Abstract

Background: Intramedullary nailing is probably the best procedure for treating the long bone fractures in the lower limb. Such operation is guided by fluoroscopy for the guide-wire insertion like fracture reduction and distal locking. Radiation exposure during interlocked nailing continues a matter of challenge. Objectives: The aim of this experimental study was to design and test the new aiming device for closed intramedullary nailing and to reduce the radiation exposure and the operation time during the procedure. Materials and Methods: A stainless steel femoral intramedullary guide wire equipped with a small magnet on its end was designed; and also an exchange tube that would enter into the bone canal upon the guide wire to maintain the alignment. Besides these mentioned parts, we applied the standard classic interamedullary nailing set. Pin guide was inserted in the femoral intramedullary canal from periformis fossa. Another equipped magnetic guide wire was inserted from distal portal which was created in the lateral epicondyle. Two opposite magnetic poles supposed to find each other in the fracture site. After replacing the guide-wire with guide pine; the alignment would be checked by a C-arm. The study has been designed in 4 phases including moulage phase, animal phase on young cows, and a human cadaveric phase. The last step of the study is under design and it consists of a randomized controlled clinical trial on the elective patients. Results: Outcomes of applying the new system on 15 fiberglass artificial femurs and 20 bovine femurs as well as 10 human cadaveric femurs were successful. Conclusions: We found the magnetic field assistant device to be an accurate, radiation-independent jig for close passing of guide wire after close reduction of femoral fracture. It can reduce the need for radiation during placement of guide wire for closed intramedullary nailing of the long bones. More studies are required to improve and evaluate the technique and equipment.

Keywords


  1. 1.Logters T, Windolf J, Flohe S. [Fractures of the shaft of the femur]. Unfallchirurg. 2009;112(7):635–50.

    1. Ikem IC, Ogunlusi JD, Ine HR. Achieving interlocking nails without using an image intensifier. Int Orthop. 2007;31(4):487–90.
    2. Hooper GJ, Keddell RG, Penny ID. Conservative management or closed nailing for tibial shaft fractures. A randomised prospective trial. J Bone Joint Surg Br. 1991;73(1):83–5.
    3. Fadero PE, Alabi S, Adebule GT, Odunubi OO, Yinusa W, Eyesan SU, et al. Locked intramedullary nailing for the treatment of femoral shaft fractures: experience and result in 19 cases. Niger J Med. 2008;17(2):168–72.
    4. Barry TP. Radiation exposure to an orthopedic surgeon. Clin Orthop Relat Res. 1984(182):160–4.
    5. Dosch JC, Dupuis M, Beck G. [Radiation measurements during interlocking nailing]. Hefte Unfallheilkd. 1983;161:36–8.
    6. Krettek C, Mannss J, Konemann B, Miclau T, Schandelmaier P, Tscherne H. The deformation of small diameter solid tibial nails with unreamed intramedullary insertion. J Biomech. 1997;30(4):391–4.
    7. Krettek C, Schandelmaier P, Tscherne H. Nonreamed interlocking nailing of closed tibial fractures with severe soft tissue injury. Clin Orthop Relat Res. 1995(315):34–47.
    8. Mehlman CT, Dipasquale TG. Radiation exposure to the orthopaedic surgical team during fluoroscopy: "how far away is far enough?". J Orthop Trauma. 1997;11(6):392–8.
    9. Muller LP, Suffner J, Wenda K, Mohr W, Rommens PM. Radiation exposure to the hands and the thyroid of the surgeon during intramedullary nailing. Injury. 1998;29(6):461–8.
    10. Madan S, Blakeway C. Radiation exposure to surgeon and patient in intramedullary nailing of the lower limb. Injury. 2002;33(8):723–7. Ebrahimzadeh MH et al. 4 Razavi Int J Med. 2014;2(3):e22321 12. Kirousis G, Delis H, Megas P, Lambiris E, Panayiotakis G. Dosimetry during intramedullary nailing of the tibia. Acta Orthop. 2009;80(5):568–72.
    11. Whatling GM, Nokes LD. Literature review of current techniques for the insertion of distal screws into intramedullary locking nails. Injury. 2006;37(2):109–19.
    12. Gugala Z, Nana A, Lindsey RW. Tibial intramedullary nail distal interlocking screw placement: comparison of the free-hand versus distally-based targeting device techniques. Injury. 2001;32 Suppl 4:SD21–5.
    13. Kelley SS, Bonar S, Hussamy OD, Morrison JA. A simple technique for insertion of distal screws into interlocking nails. J Orthop Trauma. 1995;9(3):227–30.
    14. Krettek C, Konemann B, Miclau T, Kolbli R, Machreich T, Kromm A, et al. A new mechanical aiming device for the placement of distal interlocking screws in femoral nails. Arch Orthop Trauma Surg. 1998;117(3):147–52.
    15. Levin PE, Schoen RW, Jr, Browner BD. Radiation exposure to the surgeon during closed interlocking intramedullary nailing. J Bone Joint Surg Am. 1987;69(5):761–6.
    16. Miller ME, Davis ML, MacClean CR, Davis JG, Smith BL, Humphries JR. Radiation exposure and associated risks to operating-room personnel during use of fluoroscopic guidance for selected orthopaedic surgical procedures. J Bone Joint Surg Am. 1983;65(1):1–4.
    17. Sanders R, Koval KJ, DiPasquale T, Schmelling G, Stenzler S, Ross E. Exposure of the orthopaedic surgeon to radiation. J Bone Joint Surg Am. 1993;75(3):326–30.
    18. Anastopoulos G, Ntagiopoulos PG, Chissas D, Papaeliou A, Asimakopoulos A. Distal locking of tibial nails : a new device to reduce radiation exposure. Clin Orthop Relat Res. 2008;466(1):216–20. 21. Abdlslam KM, Bonnaire F. Experimental model for a new distal locking aiming device for solid intramedullary tibia nails. Injury. 2003;34(5):363–6.
    19. Tsalafoutas IA, Tsapaki V, Kaliakmanis A, Pneumaticos S, Tsoronis F, Koulentianos ED, et al. Estimation of radiation doses to patients and surgeons from various fluoroscopically guided orthopaedic surgeries. Radiat Prot Dosimetry. 2008;128(1):112–9.
    20. Babis GC, Benetos IS, Zoubos AB, Soucacos PN. The effectiveness of the external distal aiming device in intramedullary fixation of tibial shaft fractures. Arch Orthop Trauma Surg. 2007;127(10):905–8.
    21. Karachalios T, Babis G, Tsarouchas J, Sapkas G, Pantazopoulos T. The clinical performance of a small diameter tibial nailing system with a mechanical distal aiming device. Injury. 2000;31(6):451–9.