Document Type : Original Article
Orthopedic Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, IR Iran
Department of Research and Education, Razavi Hospital, Mashhad, IR Iran
Background: Intramedullary nailing is probably the best procedure for treating the long bone fractures in the lower limb. Such operation is guided by fluoroscopy for the guide-wire insertion like fracture reduction and distal locking. Radiation exposure during interlocked nailing continues a matter of challenge. Objectives: The aim of this experimental study was to design and test the new aiming device for closed intramedullary nailing and to reduce the radiation exposure and the operation time during the procedure. Materials and Methods: A stainless steel femoral intramedullary guide wire equipped with a small magnet on its end was designed; and also an exchange tube that would enter into the bone canal upon the guide wire to maintain the alignment. Besides these mentioned parts, we applied the standard classic interamedullary nailing set. Pin guide was inserted in the femoral intramedullary canal from periformis fossa. Another equipped magnetic guide wire was inserted from distal portal which was created in the lateral epicondyle. Two opposite magnetic poles supposed to find each other in the fracture site. After replacing the guide-wire with guide pine; the alignment would be checked by a C-arm. The study has been designed in 4 phases including moulage phase, animal phase on young cows, and a human cadaveric phase. The last step of the study is under design and it consists of a randomized controlled clinical trial on the elective patients. Results: Outcomes of applying the new system on 15 fiberglass artificial femurs and 20 bovine femurs as well as 10 human cadaveric femurs were successful. Conclusions: We found the magnetic field assistant device to be an accurate, radiation-independent jig for close passing of guide wire after close reduction of femoral fracture. It can reduce the need for radiation during placement of guide wire for closed intramedullary nailing of the long bones. More studies are required to improve and evaluate the technique and equipment.