Ενδομυελική ήλωση μακρών οστών με τον ήλο S2

Abstract

Intramedullary nailing is a well known, successful and widely accepted method in treatment of diaphyseal fractures (and not only) of long bones. After more than a half of century of application of intramedullary nails, important experience has been acquired and for many Orthopaedic surgeons the specific method constitutes the treatment of choice in the daily chirurgical practice. Many aspects of the method have been studied extensively but the part of distal locking of intramedullary nails continues to be troubleshooting for many Surgeons. “Free-hand” technique is excessively used as a targeting method for distal locking despite the fact that it is a time-consuming process, frequently traumatic and mainly aggravating with radiation, as the use of image intensifier is mandatory intra-operatively. Mechanical targeting devices (in many variants) that up to now have been used, can help. However the deformation of nail, usually inevitable during its import in the intramedullary canal, turns out to be the main cause of limited effectiveness. This, in combination with the relatively complex equipment, but also the required learning time of technique, usually discourage surgeon of using these mechanical targeting devices and finally the free-hand technique turns again to be the method of choice in distal locking. The extensive henceforth, use of computers in operating theatre has also found a challenging field of application in this subject. Complicate software with corresponding equipment and methodology aspire to drive surgeon’s hand with precision to distal screw holes of intramedullary nails. Still, such systems seem to be “script of future” for the average Orthopaedic surgeon. High requirements in know-how and equipment, in combination with considerable cost of computer-assisted navigation, are strong reasons for not being considered as a realistic solution on the present. S2 nails with associated distal targeting system, belong in the category of nail mounted, mechanical targeting devices. Without differing considerably in requirements and learning demands from the Surgeon (and the assisting personnel in operating theatre), in comparison with other mechanical devices, it presents one particular characteristic. The adaptability of targeting system provides the ability of damping of nail deformation (during intramedullary application), inside limits with appreciable breadth. This dissertation presents the measurable findings of the first 190 cases of femoral and tibial shaft fractures treated by intramedullary nailing with S2TM nail and S2TM distal targeting device, and also a comparative study between S2 distal targeting device and ‘free-hand’ technique for G-K distal locking. The interest was focused in the effectiveness of the device, the duration of the procedure (distal locking screws placement and total intramedullary nailing time) and particularly in the reduction of image intensifier use (reduction of patient, surgeon and personnel exposition to x-rays). Results were compared to bibliographic data of other well-studied methods of distal targeting in intramedullary nailing and in conclusion, S2TM nail and its distal targeting device is a significantly effective and mainly minimally aggravating with x-ray radiation, method.