Abstract
Introduction
Locking nail have considerably improved the treatment of long weight bearing bones. However, distal locking needs experience and may expose to radiations. Many methods have been proposed to facilitate distal locking and improve safety. Recently, an external distal targeting device adapted to the ancillary of the Long Gamma Nail has been proposed. We report our experience with this device through a comparative series of distal lockings. Aim of this work was to assess feasibility and advantages brought about with this targeting device when considering time or dose of irradiation.
Material and methods
Two prospective series of 50 distal locking performed by an experienced surgeon have been compared. Two methods were compared: the classical freehand technique using a Steinmann rod with the image of rounded holes, and the external distal targeting device. The following datas were collected: technical difficulties with either technique, locking mistakes and duration of exposure to radiations.
Results
Two locking errors were observed using the targeting device, in pathological fractures with the use of a titanium nail. These cases belonged to the five earliest cases. External targeting device requires a learning curve that is reasonnably short with little difficulties encountered. Ther is a fundamental difference between the two series concerning exposure to radiations. In the freehand technique mean exposure was 25,8s (6–38) and it was 8,6s (6–18) with the dital targeting device.
Discussion
A short learning curve confirms the ease of use of the distal targerting device. Diminution of exposure to radiation is effectively obtained. Some factors may increase the risk of error: the use of very long nails and the use of titanium nails as this may increase motion at distal end.
Conclusion
The external visor is an efficient device as it facilitates distal locking and alllows for a diminution of irradiation time.
