The Use Of The Fiberoptics For The Accurate Determination Of The Distal Holes Of The Interlocking Nail:

Bassem Abdel-ghany Darwish

SummaryThe practice of intramedullary fixation started very early in the 19th centurybut it has not gained popularity except after second world war and a lot ofdevelopment has been done to Kiintscher’s original design until we reachedthe intramedullary interlocking nails used now whether classic nail withproximal and distal locking screws(reamed or undreamed, static or dynamic),self locked nail from inside (HEN), and callus distraction nail whethermechanical systems like Albizzia and ISKD nail or fully motorized systemslike Fitbone nail.Reaming as a part of preparation for insertion of the interlockingintramedullary nail and the autograft theory and its effect on union has beenproved and although the new generation of reamer head decreasesintramedUllary pressure during reaming and resultant temperature butreaming should not be primarily practiced in polytraumatised patients.Alloys used to synthesize interlocking intramedullary nail include:- stainlesssteel (316 LVM, Orthinox, and 22-13-5), titanium alloys(CP Ti,Ti-6AI-4V, andTi-6Al-7Nb), and cobalt chromium alloys (cast vitallium, and wroughtvitallium). These alloys are characterized by being tolerated by the body,restore physiological loading and result in strains and stresses that arecompatible with the requirements of the adjacent bony and soft tissuestructures, allow all imaging modes with minimum distortion, allow easyimplantation and explanation, and maintain the balance between cost andefficiency.Interlocking intramedullary nail could be coated with combination of SiOxplasma polymer and metallic silver in the form of high-porosity silverparticles forming films with a thickness well below 100 nm, which ischemically inert, insoluble, mechanically and thermally stable, and exhibitshigh antimicrobial activity.150As regards locking screws; tbe proximal locking screw could be insertedsuccessfully by tbe mecbanical target device incorporated in the insertionhandle of the nail because the distance between the bandle and the proximalboles is sbort. Tbe distal locking screws are inserted eitber by; tbe free bandtechnique, mechanical distal target device, navigator, or recently byfiberoptics’ tecbnique whicb bas been proved by tbe thesis to be bigblysuccessful for tbe accurate determination of tbe sites of the distal boles of tbeinterlocking nail witbout tbe need for image intensifier or navigator takinginto consideration tbat tbe cost efficiency of tbis tecbnique is mucb lower tbanotber tecbniques.