ELECTROMAGNETIC NAVIGATION INTERLOCKING INTRAMEDULLARY NAIL TECHNOLOGY FOR TREATMENT OF FEMORAL SHAFT FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZUOKangkang ¹ , QINWei ² , GUOQing ³ , Palati·Ababaikeli ¹ , QIAOPeiliu ¹ , SHENMingquan ¹ , YINLele ¹ , PANQilin ¹ ,  XUXiaoxiong ¹

1. Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830000, P. R. China;
2. Department of Orthopedics, Central Hospital of Xiangyang;
3. Department of Teaching Office, Central Hospital of Xiangyang;

Corresponding author：

XUXiaoxiong, Email: zkkgh@hotmail.com

Keywords：

Electromagnetic navigation; Interlocking intramedullary nail; Distal locking nail; Femoral shaft fracture

DOI：

10.7507/1002-1892.20140261

Video：

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Objective To explore the value of electromagnetic navigation interlocking intramedullary nail in the treatment of femoral shaft fracture. Methods Between July 2012 and October 2013, 53 cases of femoral shaft fracture were treated. There were 40 males and 13 females, aged 16-52 years (mean, 38.3 years). The causes of injury were traffic accident in 28 cases, falling from height in 11 cases, falling in 7 cases, crush injury in 4 cases, and other in 3 cases. Of 53 cases, there were 3 cases of open fracture (Gustilo I degree) and 50 cases of closed fracture. Fracture was located in the proximal femur in 17 cases, middle femur in 29 cases, and distal femur in 7 cases. According to Winquist classification, 7 cases were rated as type I, 8 cases as typeⅡ, 22 cases as typeⅢ, and 16 cases as type IV; according to AO classification, 18 cases were rated as type 32-A, 28 cases as type 32-B, and 7 cases as type 32-C. The time from injury to operation was 3-11 days (mean, 5 days). Distal interlocking intramedullary nail was implanted using electromagnetic navigation. Results The distal locking nail operation with interlocking intramedullary nail was successfully completed under electromagnetic navigation; the one-time success rate of distal locking nail operation reached 100%; and the locking nail time was 5.0-9.5 minutes (mean, 7.0 minutes). Healing of incision by first intention was obtained after operation, and no complication of skin necrosis, infection, and sinus tract occurred. Fifty-three cases were all followed up 5-12 months (mean, 9 months). One case had hip pain and weaken middle gluteal muscle strength, and the symptoms disappeared after removing the nail. During the follow-up period, no broken nails, nail exit, infection, or re-fracture occurred. All fractures achieved clinical healing, and the healing time was 8-22 weeks (mean, 14.5 weeks). In 49 patients followed up 8 months, the Lysholm score was excellent in 44 cases, good in 4 cases, and acceptable in 1 case, with an excellent and good rate of 98%. Conclusion Electromagnetic navigation system is safe and reliable, with the advantages of high positioning accuracy, short operation time, and no radiation, the clinical application of the system for distal locking nail operation can obtain excellent short-term effectiveness.

Citation： ZUOKangkang, QINWei, GUOQing, Palati·Ababaikeli, QIAOPeiliu, SHENMingquan, YINLele, PANQilin, XUXiaoxiong. ELECTROMAGNETIC NAVIGATION INTERLOCKING INTRAMEDULLARY NAIL TECHNOLOGY FOR TREATMENT OF FEMORAL SHAFT FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1204-1207. doi: 10.7507/1002-1892.20140261 Copy

1.	Wolinsky PR, McCarty E, Shyr Y, et al.Reamed intramedullary nailing of the femur:551 cases.J Trauma, 1999, 46(3):392-399.
2.	谢洋, 陈小强, 王金华, 等.磁力导航交锁髓内钉在治疗胫骨干骨折中的应用.临床骨科杂志, 2010, 13(3):307-309.
3.	Langfitt MK, Halvorson JJ, Scott AT, et al.Distal locking using an electromagnetic field-guided computer-based real-time system for orthopaedic trauma patients.J Orthop Trauma, 2013, 27(7):367-372.
4.	Hoffmann M, Schröder M, Lehmann W, et al.Next generation distal locking for intramedullary nails using an electromagnetic X-ray-radiation-free real-time navigation system.J Trauma Acute Care Surg, 2012, 73(1):243-248.
5.	Moreschini O, Petrucci V, Cannata R.Insertion of distal locking screws of tibial intramedullary nails:a comparison between the free-hand technique and the SURESHOTTM Distal Targeting System.Injury, 2014, 45(2):405-407.
6.	Lysholm J, Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med, 1982, 10(3):150-154.
7.	杨曦, 孔清泉, 宋跃明, 等.计算机导航辅助椎弓根螺钉后路固定在骨质疏松患者中的临床应用.中国修复重建外科杂志, 2012, 26(2):196-200.
8.	孙麟, 宋跃明, 龚全, 等.实时三维导航技术应用于先天性脊柱侧凸矫形的近期疗效.中国修复重建外科杂志, 2013, 27(2):129-134.
9.	Marcus MS, Yoon RS, Langford J, et al.Is there a role for intramedullary nails in the treatment of simple pilon fractures? Rationale and preliminary results.Injury, 2013, 44(8):1107-1111.
10.	Ramos L, Bertrand ML, Benitez-Parejo N, et al.How many distal bolts should be used in unreamed intramedullary nailing for diaphyseal tibial fractures? Injury, 2012, 43 Suppl 2:S59-62.
11.	Jankovic A, Korac Z, Bozic NB, et al.Influence of knee flexion and atraumatic mobilisation of infrapatellar fat pad on incidence and severity of anterior knee pain after tibial nailing.Injury, 2013, 44 Suppl 3:S33-39.
12.	Hernández-Vaquero D, Suárez-Vázquez A, Iglesias-Fernández S, et al.Dynamisation and early weight-bearing in tibial reamed intramedullary nailing:its safety and effect on fracture union.Injury, 2012, 43 Suppl 2:S63-67.
13.	Whatling GM, Nokes LD.Literature review of current techniques for the insertion of distal screws into intramedullary locking nails.Injury, 2006, 37(2):109-119.
14.	Boraiah S, Barker JU, Lorich D.Efficacy of an aiming device for the placement of distal interlocking screws in trochanteric fixation nailing.Arch Orthop Trauma Surg, 2009, 129(9):1177-1182.
15.	Durakbaşa O, Haklar U, Tuygun H, et al.Intramedullary nailing of adult femoral fractures.Acta Orthop Traumatol Turc, 2002, 36(4):316-321.
16.	Rohilla R, Singh R, Magu N, et al.Nail over nail technique for distal locking of femoral intramedullary nails.Int Orthop, 2009, 33(4):1107-1112.
17.	Uruc V, Ozden R, Dogramaci Y, et al.The comparison of freehand fluoroscopic guidance and electromagnetic navigation for distal locking of intramedullary implants.Injury, 2013, 44(6):863-866.
18.	Lionberger DR, Weise J, Ho DM, et al.How does electromagnetic navigation stack up against infrared navigation in minimally invasive total knee arthroplasties? J Arthroplasty, 2008, 23(4):573-580.
19.	Stathopoulos I, Karampinas P, Evangelopoulos DS, et al.Radiation-free distal locking of intramedullary nails:evaluation of a new electromagnetic computer-assisted guidance system.Injury, 2013, 44(6):872-875.
20.	Chan DS, Burris RB, Erdogan M, et al.The Insertion of intramedullary nail locking screws without fluoroscopy:a faster and safer technique.J Orthop Trauma, 2013, 27(7):363-366.

1. Wolinsky PR, McCarty E, Shyr Y, et al.Reamed intramedullary nailing of the femur:551 cases.J Trauma, 1999, 46(3):392-399.
2. 谢洋, 陈小强, 王金华, 等.磁力导航交锁髓内钉在治疗胫骨干骨折中的应用.临床骨科杂志, 2010, 13(3):307-309.
3. Langfitt MK, Halvorson JJ, Scott AT, et al.Distal locking using an electromagnetic field-guided computer-based real-time system for orthopaedic trauma patients.J Orthop Trauma, 2013, 27(7):367-372.
4. Hoffmann M, Schröder M, Lehmann W, et al.Next generation distal locking for intramedullary nails using an electromagnetic X-ray-radiation-free real-time navigation system.J Trauma Acute Care Surg, 2012, 73(1):243-248.
5. Moreschini O, Petrucci V, Cannata R.Insertion of distal locking screws of tibial intramedullary nails:a comparison between the free-hand technique and the SURESHOTTM Distal Targeting System.Injury, 2014, 45(2):405-407.
6. Lysholm J, Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med, 1982, 10(3):150-154.
7. 杨曦, 孔清泉, 宋跃明, 等.计算机导航辅助椎弓根螺钉后路固定在骨质疏松患者中的临床应用.中国修复重建外科杂志, 2012, 26(2):196-200.
8. 孙麟, 宋跃明, 龚全, 等.实时三维导航技术应用于先天性脊柱侧凸矫形的近期疗效.中国修复重建外科杂志, 2013, 27(2):129-134.
9. Marcus MS, Yoon RS, Langford J, et al.Is there a role for intramedullary nails in the treatment of simple pilon fractures? Rationale and preliminary results.Injury, 2013, 44(8):1107-1111.
10. Ramos L, Bertrand ML, Benitez-Parejo N, et al.How many distal bolts should be used in unreamed intramedullary nailing for diaphyseal tibial fractures? Injury, 2012, 43 Suppl 2:S59-62.
11. Jankovic A, Korac Z, Bozic NB, et al.Influence of knee flexion and atraumatic mobilisation of infrapatellar fat pad on incidence and severity of anterior knee pain after tibial nailing.Injury, 2013, 44 Suppl 3:S33-39.
12. Hernández-Vaquero D, Suárez-Vázquez A, Iglesias-Fernández S, et al.Dynamisation and early weight-bearing in tibial reamed intramedullary nailing:its safety and effect on fracture union.Injury, 2012, 43 Suppl 2:S63-67.
13. Whatling GM, Nokes LD.Literature review of current techniques for the insertion of distal screws into intramedullary locking nails.Injury, 2006, 37(2):109-119.
14. Boraiah S, Barker JU, Lorich D.Efficacy of an aiming device for the placement of distal interlocking screws in trochanteric fixation nailing.Arch Orthop Trauma Surg, 2009, 129(9):1177-1182.
15. Durakbaşa O, Haklar U, Tuygun H, et al.Intramedullary nailing of adult femoral fractures.Acta Orthop Traumatol Turc, 2002, 36(4):316-321.
16. Rohilla R, Singh R, Magu N, et al.Nail over nail technique for distal locking of femoral intramedullary nails.Int Orthop, 2009, 33(4):1107-1112.
17. Uruc V, Ozden R, Dogramaci Y, et al.The comparison of freehand fluoroscopic guidance and electromagnetic navigation for distal locking of intramedullary implants.Injury, 2013, 44(6):863-866.
18. Lionberger DR, Weise J, Ho DM, et al.How does electromagnetic navigation stack up against infrared navigation in minimally invasive total knee arthroplasties? J Arthroplasty, 2008, 23(4):573-580.
19. Stathopoulos I, Karampinas P, Evangelopoulos DS, et al.Radiation-free distal locking of intramedullary nails:evaluation of a new electromagnetic computer-assisted guidance system.Injury, 2013, 44(6):872-875.
20. Chan DS, Burris RB, Erdogan M, et al.The Insertion of intramedullary nail locking screws without fluoroscopy:a faster and safer technique.J Orthop Trauma, 2013, 27(7):363-366.

Chinese Journal of Reparative and Reconstructive Surgery

ELECTROMAGNETIC NAVIGATION INTERLOCKING INTRAMEDULLARY NAIL TECHNOLOGY FOR TREATMENT OF FEMORAL SHAFT FRACTURES

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