title: Distal locking of tibial nails : a new device to reduce radiation exposure.
abstract: The indications for intramedullary nailing have expanded to include most tibial shaft fractures. Nail design has improved since their first introduction, but distal locking remains a difficult part of the procedure, resulting in radiation exposure to the patient and the surgeon and increased operation time. To address these issues, we describe an alternative surgical technique using a newly designed distal targeting device that consists of a proximally mounted aiming arm, and we report the preliminary data from its use in all tibial shaft fractures amenable to surgery for a 2-year period. Sixty-three tibial shaft fractures were treated with this method. The mean duration of the distal locking was 6.5 minutes, and in all successful cases, radiation exposure for distal locking was two shots (one shot before targeting and another for the confirmation of proper screw insertion). Radiation exposure was on average 0.85 seconds (range, 0.4-1.2 seconds) and 1.4 mGy (range, 0.8-1.9 mGy). There were no major intraoperative complications related to the technique. The method has certain advantages and can reduce radiation exposure and operation time. Nonetheless, familiarity with the instrumentation is a prerequisite for accurate distal locking.
  
  
  METHODS
  Level IV Therapeutic study.
authors.affiliation: 2nd Department of Orthopaedic and Trauma Surgery, G. Gennimatas General Hospital of Athens, 56-60, Koniari Street, 115 21 Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Anastopoulos
authors.forename: Panagiotis G
authors.initials: PG
authors.lastname: Ntagiopoulos
authors.forename: Dionisios
authors.initials: D
authors.lastname: Chissas
authors.forename: Athanasios
authors.initials: A
authors.lastname: Papaeliou
authors.forename: Antonios
authors.initials: A
authors.lastname: Asimakopoulos
mesh_terms: D001858:Bone Nails; D004867:Equipment Design; D004869:Equipment Safety; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors