A Technique for Closed Interlocking Nailing of Midshaft Tibial Fractures without Image Intensification

Objective: In this study, we evaluated the reliability, reproducibility and final outcome of our techniques for performing image independent tibial interlocking nailing. Design: Prospective. Setting: Tertiary teaching hospital (level I trauma center). Patients/participants: A total of 29 patients were selected for the study (21 males and 8 females patients). Intervention: Locked tibial intramedullary nailings were performed in the selected subjects, using the standard AO interlocking nail (SynthesTM, Switzerland), utilizing our improvisations of the standard technique. Main outcome measurements: The successful completion of the technique was the prime parameter evaluated. Total surgical time, time taken for placement of each distal bolt, fluoroscopy time (when used) and postoperative alignment and reduction were evaluated. The patients were followed at 4 weekly intervals. Results: The average duration of the surgery was 78.6 minutes. The mean distal locking time was 16.2 ± 1.4 minutes. Fluoroscopy had to be used in three cases, when the distal locking by the ‘nail-over-nail’ technique failed. In one case, the intra medullary position of the guidewire had to be verified. Thus, 26 out of 30 (86.7%) cases were performed without any imaging assistance. In two cases, the fracture site had to be opened after difficulties were encountered in achieving closed reduction. Thus, 24 out of 30 procedures (80%) were successfully completed by our technique. The fractures were followed to union and the long-term results were comparable to the results of tibial fracture operated by image assistance. Conclusion: The technique described here can come handy in situations of image intensifier failure. Routine use of part of the steps can assist in reducing radiation exposure during interlocking nailings.