DEFORMATION OF FEMORAL NAILS WITH INTRAMEDULLARY INSERTION

Current methods of distal interlocking of intramedullary femoral nails are dependent on image intensification. However, radiation exposure t o the patient, the operating room staff, and the surgeon remains a con cern. Proximally mounted, radiation-free aiming systems for distal int erlocking of femoral nails have reportedly failed because of nail defo rmation with insertion. To better understand this deformation, a three -dimensional magnetic motion tracking system was used to determine the position of the distal interlocking hole following nail insertion. Th e amount and direction of deformation of commercially available small- diameter implants (unslotted 9-mm nails inserted without reaming) and large-diameter implants (slotted 13-mm nails inserted with reaming) fr om a single manufacturer were analyzed. Measurements of deformation (t hree translations and three angles), based on the center of the distal transverse locking hole, were performed on 10 paired intact human cad averic femora before and after insertion. The technique produced the f ollowing results fur the small and large-diameter nails, respectively: lateral translations of 18.1 +/- 10.0 mm (mean +/- SD, range: 47.8 mm ) and 21.5 +/- 7.9 mm (range: 26.4 mm), dorsal translations of -3.1 +/ - 4.3 mm (range: 15.2 mm) and 0.4 +/- 9.8 mm (range: 30.1 mm), and rot ation about the longitudinal axes of -0.1 +/- 0.20 (range: 0.7 degrees ) and 10.0 +/- 3.1 degrees (range: 7.8 degrees), This technique is use ful for measuring insertion-related femoral nail deformation. The data for the nails tested suggest that a simple aiming arm, mounted on the proximal end of the femoral nail alone, will not sufficiently provide accurate distal aiming.