Perceptions and realities for distal freehand interlocking of intramedullary nails.

Robert F Ostrum

doi:10.1155/2015/834582

Abstract

There is a perception that distal freehand interlocking (DFHI) of intramedullary nails can be difficult and time consuming. This study consists of a survey of surgeons' practices for DFHI screws and their reasons for not using this technique. A survey was sent to 1400 orthopaedic surgeons who were asked to agree or disagree with statements regarding the difficulty and indications for the usage of distal freehand interlocking screws. The results were analyzed by practice demographics, resident availability, and completion of an orthopaedic trauma fellowship. Overall, 316 surgeons (22.6%) responded to the survey. Fellowship trained surgeons were 60% less likely to find DFHI difficult when compared to nonfellowship surgeons and surgeons with residents were 76% less likely to perceive DFHI as difficult than surgeons without residents. In all groups, 40–43% of surgeons used distal interlocking based on their comfort with the technique and not the fracture pattern. Distal freehand interlocking is perceived as difficult by community orthopaedic surgeons without residents and surgeons who have not done an orthopaedic trauma fellowship. Forty percent of surgeons based their usage of DFHI screws on their comfort with the technique and not the fracture pattern.

Highlights

Proximal femur fractures are a common injury treated by orthopaedic surgeons
When questioned about whether “distal freehand interlocking (DFHI) is an easy, learnable technique,” the with fellowship (WF) surgeons were 6.8 times more likely to agree that DFHI is learned than the not have a fellowship (NF) surgeons
As for “my choice to use DFHI screws is based on my comfort with the technique and not the fracture pattern,” 41% of all surgeons used distal freehand interlocking based on their comfort with the technique and not the fracture pattern

Summary

Introduction

Proximal femur fractures are a common injury treated by orthopaedic surgeons. Currently, a large number are surgically treated with an intramedullary nail (IMN). Some orthopaedic surgeons have progressed to using a long intramedullary device to treat proximal femur fractures to avoid the complications seen with short nails and because they believe that these fractures, often associated with osteoporosis, represent a pathologic fracture [15]. The use of a long intramedullary nail requires the surgeon to employ the technique of distal freehand interlocking screw placement. This cannot be done with the assistance of a jig and requires some level of surgical expertise and additional operating room and fluoroscopic time

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