title: Interlocking screws placed with freehand technique and uni-planar image intensification: the "dip-stick" technique.
abstract: OBJECTIVE
  To report our experience with a novel alternative method of freehand interlocking of intramedullary nails. This method requires the use of only anterior-posterior image intensification and an intramedullary guide wire to verify screw placement. Our results are compared with historical results in the literature.
  
  
  METHODS
  A total of 815 patients were treated using this technique from January 2008 to December 2012; 603 patients had fractures of the tibia and 212 had fractures of the femur.
  
  
  RESULTS
  The mean duration of surgery for tibial shaft fractures was 55.6 minutes (range 42-60 minutes) and that for fractures of the femur was 78 minutes (range 50-90 minutes). The mean time for each distal locking was 3.8 minutes (2.5-5.1 minutes), with 7.65 seconds of exposure to radiation during each block.
  
  
  CONCLUSIONS
  The surgical technique is simple, easy and reproducible. Mean time of surgery and radiation exposure was less than that in the literature. A comparative study should be performed.
authors.affiliation: Department of Orthopaedic Trauma Surgery, "Dr Carmino Caricchio" Tatuapé Municipal Hospital and Federal University of São Paulo (DOT-UNIFESP), São Paulo - Brazil. Electronic address: cecot@traumatatuape.com.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Finelli
authors.affiliation: The Hughston Clinic at Gwinnett Medical Centre, Atlanta, Georgia, USA.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Ziran
authors.affiliation: Department of Orthopaedic Trauma Surgery, "Dr Carmino Caricchio" Municipal Hospital, São Paulo - Brazil.
authors.forename: Alexandre Penna
authors.initials: AP
authors.lastname: Torini
authors.affiliation: Department of Orthopaedic Trauma Surgery, Federal University of São Paulo (DOT-UNIFESP), São Paulo, Brazil.
authors.forename: Hélio Jorge A
authors.initials: HJ
authors.lastname: Fernandes
authors.affiliation: Department of Orthopaedic Trauma Surgery, Federal University of São Paulo (DOT-UNIFESP), São Paulo, Brazil.
authors.forename: Fernando Baldy
authors.initials: FB
authors.lastname: Dos Reis
mesh_terms: D001863:Bone Screws; D004866:Equipment Contamination / Q000517:prevention & control; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D006801:Humans; D061646:Operative Time; D011446:Prospective Studies; D011829:Radiation Dosage; D011835:Radiation Protection; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Distal locking; Image intensification; Intramedullary nail