Ewha Med J.  2024 Jul;47(3):e39. 10.12771/emj.2024.e39.

Straightforward, safe, and efficient interlocking screw insertion during intramedullary nailing using a Steinmann pin and hammer: a comparative study

• Deslivia MF
• Kim HJ
• Kim SH
• Lee SJ

• KMID: 2558576
• DOI: http://doi.org/10.12771/emj.2024.e39

Abstract

Objectives
Accurately targeting distal nail holes and placing distal interlocking screws pose challenges during intramedullary nailing. This study proposes a straightforward technique for distal locking screw insertion using a Steinmann pin, eliminating the need to reposition the pin or drill bit.
Methods
We utilized 18 Sawbones femur models and intramedullary femur nails. A first-year resident created two distal locking holes on each model, employing both the conventional freehand technique and a novel method involving a Steinmann pin and hammer under image intensification. These techniques were evaluated based on three parameters: (1) the time required to create distal locking holes, measured from the moment the pin was positioned at the center of the hole until the far cortex was drilled through the interlocking hole; (2) the radiation dose (in mrem/h), as estimated with a personal gamma radiation dosimeter; and (3) the number of failures, defined as the creation of more than one hole in the near and far cortex.
Results
The new technique was associated with a lower radiation dose (P=0.0268) and fewer failures (P=0.0367) than the conventional approach. Additionally, the time required to establish distal holes was shorter using the new technique compared to the conventional method (P=0.0217).
Conclusion
The creation of distal interlocking holes with a Steinmann pin and hammer is accurate, efficient, and cost-effective.

Keyword

Bone screws; Cost-benefit analysis; Femur; Fracture; Radiation dosage

Figure

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  Fig. 1. The drilling machine was detached from the Steinmann pin after insertion into the near cortex. Subsequently, the pin was bent to align with the path to the hole, under image intensifier guidance.

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  Fig. 2. Once the direction was confirmed, the Steinmann pin was tapped into place with a hammer.

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  Fig. 3. A Steinmann pin is shown reaching the far cortex after passing through the interlocking hole.

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  Fig. 4. Comparison of procedure time between the conventional technique (Conv) and the new method (New) for intramedullary nailing. Values are presented in seconds.

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  Fig. 5. Comparison of radiation dose administered to the Sawbones between the conventional technique (Conv) and the new method (New) for intramedullary nailing. Values represent doses of radiation, in millirem/hour.

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  Fig. 6. Comparison of the frequency of attempts between the conventional technique (Conv) and the new method (New) for intramedullary nailing. Values represent frequencies of attempts.

Reference

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