title: A forward-striking technique for reducing fracture gaps during intramedullary nailing: A technical note with clinical results.
abstract: BACKGROUND
  A residual postoperative fracture gap between major bone fragments following intramedullary nailing of long-bone fractures is recognised as one of the major risk factors for delayed union and non-union. The most common method for reducing a fracture gap after nail insertion is through application of the backstroke technique. We introduce forward-striking as a new and simple technique that can be used to reduce fracture gaps during cephalomedullary or intramedullary nailing.
  
  
  METHODS
  The forward-striking technique was used in 20 patients with subtrochanteric or femoral shaft fractures and three patients with tibial shaft fractures who underwent cephalomedullary or intramedullary nailing at two university teaching hospitals between February 2013 and March 2014.
  
  
  RESULTS
  Bone union was achieved in all cases, with a mean time of 5.7 months (range, 3-9 months). No major complications, including, non-union, implant failure, or infection, were encountered during the follow-up period.
  
  
  CONCLUSIONS
  A forward-striking technique is simple, convenient, and highly efficient in terms of reducing fracture gaps during cephalomedullary or intramedullary nailing. The advantage of this technique is that it carries no risk of deforming the proximal interlocking screw, prevents excessive protrusion of the nail, and enables the lag screw to be placed into the optimal lag screw position relative to the femoral head at the time of cephalomedullary nailing. The forward-striking technique is particularly useful if no compression screw system is available.
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Lim
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Sang-Yeon
authors.initials: SY
authors.lastname: So
authors.affiliation: Orthopedic Trauma Division, Trauma Center, Gachon University Gil Hospital, Gachon University School of Medicine, Incheon, South Korea. Electronic address: dryoonyc@gmail.com.
authors.forename: Yong-Cheol
authors.initials: YC
authors.lastname: Yoon
authors.affiliation: Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University School of Medicine, Seoul, South Korea.
authors.forename: Won-Tae
authors.initials: WT
authors.lastname: Cho
authors.affiliation: Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University School of Medicine, Seoul, South Korea. Electronic address: jkoh@korea.ac.kr.
authors.forename: Jong-Keon
authors.initials: JK
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Cephalomedullary nailing; Forward-striking technique; Fracture gap; Intramedullary nailing