title: Nail over nail technique for distal locking of femoral intramedullary nails.
abstract: The free hand technique remains the most popular method for distal locking; however, radiation exposure is a major concern. In an endeavour to overcome this concern, distal locking with the nail over nail technique is evaluated. Seventy patients with femoral diaphyseal fractures treated by intramedullary nailing were divided in two groups for distal locking: either using the free hand technique (group I) or with the nail over nail technique (group II). The average number of images taken to achieve nail insertion without locking, for distal locking, and for the complete procedure in group I was 25.8, 24.2, and 50.08, respectively, compared with 24.8, 4.1, and 28.9, respectively, in group II (statistically extremely significant decrease in radiation). The nail over nail technique appears to be a reliable solution for decreasing radiation exposure during closed femoral intramedullary nailing. However, over-reaming of 1.5 mm is the key to the success of the technique.
authors.affiliation: Department of Orthopaedics, PGIMS, Rohtak, 11J-44, Medical Enclave, Rohtak, 124001, Haryana, India. drrajeshrohilla@rediffmail.com
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rohilla
authors.forename: Roop
authors.initials: R
authors.lastname: Singh
authors.forename: Narender
authors.initials: N
authors.lastname: Magu
authors.forename: Ashish
authors.initials: A
authors.lastname: Devgun
authors.forename: Ramchander
authors.initials: R
authors.lastname: Siwach
authors.forename: Ashish
authors.initials: A
authors.lastname: Gulia
mesh_terms: D000328:Adult; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome