Radiation Free Insertion of Distal Interlocking Screw by Nail over Nail Technique in Femoral / Tibial Shaft Fractures : Our Experience in a Rural Teaching Institution

Though for insertion of the distal interlocking screw in intramedullary nailing of long-bones` fracture, the free hand technique remains the standard technique, yet it remains a challenging task for orthopedic surgeons. This technique is inundated with dependence on an image intensifier which sometimes is not available at all centers especially in developing countries like ours. Also, the radiation and operative time increase with this method. It is difficult particularly when the surgeon is not much experienced. Nail over nail technique is a radiation-free technique of distal interlocking screw insertion which can easily be performed. It was a prospective study, which was conducted during the period of Dec. 2014 to July 2016 in the institute`s hospital to evaluate the results of distal locking with the nail over nail technique. Fifty six patients with femoral or tibial diaphyseal fractures, treated by intramedullary nailing, were operated during this period where this technique was used. There were 22 femoral shaft fracture and 34 tibial shaft fracture. These included 20 open fracture and 36 closed fracture. In 20 of 22 femur fractures and in 31 of 34 tibial fractures, satisfactory radiographic bony union was achieved within 6 months of follow-up. There were five cases of nonunion and all these cases were open fractures.The nail over nail technique appears to be a reliable solution for decreasing radiation exposure during closed femoral intramedullary nailing. Moreover as this method is simple, so it can be used in third world countries or in hospitals where image intensifier facility is not available.