Mr. Chezhiyan Shanmugam and Mr. James Oliver Smith
Distal interlocking of long intramedullary nails may be technically challenging, particularly following an initial failed attempt. The technique described below and shown in this video solves the problem with a cost-effective solution.
Using standard fluoroscopy techniques, a sharp-tipped 2.8mm DHS guide wire is used to create a pilot hole prior to using the thicker proprietary drill bit. This slender, flexible wire will not slip when hitched in the cortex of bone and is easier to maneuver in the image intensifier field to achieve an accurate ‘bull’s eye’ within the locking hole. Furthermore, an incorrect passage can be corrected without slipping back into the original hole. Once the correct track is made, the proprietary drill bit is used to augment that pilot hole.
Despite the sharpened tip of many drill bits designed for distal locking, the requirement to reposition the inflexible drill immediately prior to drilling and the adverse curvature of the cortex may cause the drill to skive. Additionally, its width corresponds closely to the diameter of the interlocking hole in the nail. Consequently, there is little room for error and incremental changes in position are impossible subsequent to an initial incorrect passage.
The authors have found this technique particularly useful for trainee surgeons or in challenging scenarios, where the time saved and the cost of DHS wire overcomes the excess cost of distal targeting jigs.
- Total Run Time: 03:50 minutes
- Catalog Number: 6022
- VJO Publication Date: February, 2020