title: Insertion of distal locking screws of tibial intramedullary nails: a comparison between the free-hand technique and the SURESHOT™ Distal Targeting System.
abstract: BACKGROUND
  Positioning of the distal locking screws of an intramedullary nail is often challenging and time consuming because of difficult localisation of the distal locking holes, potential screw malalignment and nail deformation during insertion. The standard free-hand technique under fluoroscopic control involves considerable radiation exposure of both the patient and the surgical team. In this study, we aimed to compare the free-hand technique with a new system that utilises electromagnetic (EM) tracking data (SURESHOT™ Distal Targeting System) to localise distal locking holes.
  
  
  METHODS
  Patients admitted from March 2010 to January 2013 for tibial fracture that required intramedullary nailing were analysed retrospectively. We compared intraoperative radiation exposure time and distal locking time in patients treated with the standard free-hand technique and distal locking using the EM field-generating device. Intraoperative radiation exposure time and distal locking time were used for comparison.
  
  
  RESULTS
  Data from a total of 50 patients were analysed. The standard free-hand technique and the EM field-generating device were used in 25 (group 1) and 25 (group 2) patients, respectively. Mean distal locking time was 1258.6 (450-2289) s in group 1 and 603.5 (360-1140)s in group 2. Mean radiation exposure time was 19.4 (6-33) s in group 1 and 4.6 (1-10) s in group 2.
  
  
  CONCLUSIONS
  The EM field-generating device significantly reduces distal locking time and, more importantly, significantly decreases duration of exposure to ionising radiation.
authors.affiliation: Department of Anatomical, Histological, Medico-Legal Sciences of the Locomotor System, University of Rome "Sapienza", Policlinico Umberto I, Roma, Italy. Electronic address: Oreste.moreschini@uniroma1.it.
authors.forename: O
authors.initials: O
authors.lastname: Moreschini
authors.affiliation: Department of Anatomical, Histological, Medico-Legal Sciences of the Locomotor System, University of Rome "Sapienza", Policlinico Umberto I, Roma, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Petrucci
authors.affiliation: Department of Anatomical, Histological, Medico-Legal Sciences of the Locomotor System, University of Rome "Sapienza", Policlinico Umberto I, Roma, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Cannata
mesh_terms: D000328:Adult; D001858:Bone Nails; D004574:Electromagnetic Fields; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects* / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D008297:Male; D016273:Occupational Exposure / Q000517:prevention & control* / Q000706:statistics & numerical data; D010348:Patient Care Team; D061214:Patient Safety; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011839:Radiation, Ionizing; D015203:Reproducibility of Results; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Distal locking; Distal screw; EM guided; Fluoroscopy; Intramedullary nailing; Radiation exposure; SURESHOT™; Tibial fracture