Objectives: Accurately targeting distal nail holes and placing distal interlocking screws pose challenges during intramedullary nailing. This study proposes a straightforward technique for distal locking screw insertion using a Steinmann pin, eliminating the need to reposition the pin or drill bit.

Methods: We utilized 18 Sawbones femur models and intramedullary femur nails. A first-year resident created two distal locking holes on each model, employing both the conventional freehand technique and a novel method involving a Steinmann pin and hammer under image intensification. These techniques were evaluated based on three parameters: (1) the time required to create distal locking holes, measured from the moment the pin was positioned at the center of the hole until the far cortex was drilled through the interlocking hole; (2) the radiation dose (in mrem/h), as estimated with a personal gamma radiation dosimeter; and (3) the number of failures, defined as the creation of more than one hole in the near and far cortex.

Results: The new technique was associated with a lower radiation dose (P=0.0268) and fewer failures (P=0.0367) than the conventional approach. Additionally, the time required to establish distal holes was shorter using the new technique compared to the conventional method (P=0.0217).

Conclusion: The creation of distal interlocking holes with a Steinmann pin and hammer is accurate, efficient, and cost-effective.

Citations

Citations to this article as recorded by  

• Unresolved policy on the new placement of 2,000 entrants at Korean medical schools and this issue of Ewha Medical Journal
  Sun Huh
  The Ewha Medical Journal.2024;[Epub]     CrossRef

The intramedullary nailing of long bone fractures, particularly, fractures of the shaft of femur in adults, is a satisfactory technique as it fulfills the objectives of fracture management. Malunion is, however, a significant problem with intramedullary nailing of the Kuntscher type, the major problem is malrotation which occurs either at the time of the operation or as a result of rotatory instability. Another from of malunion that occurs is shortening of the fracture site especially in the presence of comminution. Klemm & Schellmann(1972), and King(1980) has shown, however, by using interlocking cross-pinning technique that stable fixation can be achieved with no significant shortening and this development has extended the indications of intramedullary nailing. Four cases of femoral shaft fractures were treated by interlocking intramedullary nailing and good results were obtained at Ewha Womans University Hospital, Department of Orthopedic Surgery, Since February, 1985.

Fractures of the distal third of the femur proved to be very difficult to treat regardless of selection of treatment method whether surgical or nonsurgical. There are too many difficulties in both accurate reduction with traction and subsquent maintenance of reduction with cast when nonsurgical methods were used, as compared with the problems encountered with accurate internal fixation. Also, there are too many complications when nonoperative methods were used. Recent development of more efficient metallic devices for internal fixation and cast brace, and traction methods will improve the results of the treatments. Forty one cases of supracondylar, intercondylar, and condylar fractures of the femur, which were treated at the department of orthopaedic surgery, college of medicne, Ewha Womans Univeristy during the period from March 1970 to December 1982 has been analysed clinically, and following results were obtained:1) Among 41 cases, 27 cases(65.9%) were male. The most common cause was traffic accident with 25 cases(61.0%) and next was slipping with 7 cases(17.1%). 2) By the Neer's classification, intercondylar fractures of the femur were observed in 27 cases(65.9%), and the most commcn was type III with 11 cases. 3) By the evaluation of Schatzker and Lambert, the results of treatment were satisfactory in 72.7% of the patient with operative method, and only in 37.5% of the patient with conservative method. 4) The results, in the cases of inadequate initial management, severe comminuted supracondylar and intercondylar fractures of the femur, open fractures, prolonged immobilization of the knee joint for 13 weeks, and delayed operative internal fixation of more than 4 weeks were usually fair to good. 5) The results, in the cases of mobilization of the knee joint at 6 weeks from injuries and at 1 week from operative internal fixation were usually excellent to good. 6) Author's methods which consist of making the Z-incision of tensor fascia lata for wide exposure of the operative field, using bone hooks, and temporary fixation by two K-wires were satisfactory for easy reduction of the distal fragment-