Abstract
Introduction
Closed static interlocking nailing with c-arm guidance is the standard procedure for the treatment of closed diaphyseal fractures. In low-income settings, it is still very difficult to carry out such procedures because of few or absent image intensifiers (c-arm) despite the necessity. Authors provide a review of the literature on interlocking intramedullary nailing without fluoroscopy in resource-limited settings, followed by strategies, outcomes, and outlook.
Materials and method
A comprehensive search of the PubMed, Web of Science, Embase, and Cochrane Library databases was performed with the help of a biomedical information specialist. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.
Results
We identified 15 series of interlocking intramedullary nailing without fluoroscopy in resource-limited settings. All papers focused on the care for long bones (humerus, femur, tibia). All studies discussed the quality of the nailing operative procedure. The entry point was described in five series; the nail insertion in the proximal and distal medullary canal was good in all studies. The distal locking was missed between 0 and 27%.
Discussion
Intraoperative strategies depend on the type of bone affected, the opening of the fracture site, the fracture line, and the availability of a functional orthopaedic table. Three techniques to insert the nail in the proximal and distal fracture fragment with reduction of the fracture site are described. Insertion of distal screws is possible by using ancillary devices. Outcomes are comparable to those of the series using c-arm guidance. In low-income countries, it can been proposed as an alternative to the gold standard in resources constraints settings. In high-income setting this technique can help to reduce exposure of X-ray.
Conclusion
There is a need to improve equipment in low-income countries hospitals to make trauma surgery with c-arm a gold standard with a minimal exposure to radiation.
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References
Bong MR, Kummer FJ, Koval KJ, Egol KA (2007) Intramedullary nailing of the lowerextremity: biomechanics and biology. J Am Acad Orthop Surg 15:97–106
Kuntcher BG (1958) The Küntcher method of intramedullary fixation. J Bone Joint SurgAm 40:17–26
Kempf I, Grosse A, Lafforgue D (1978) L’apport du verrouillage dans l’enclouage cen-tromedullaire des os longs. Rev Chir Orthop 64:631–51
Jonathan P, Zirkle LG, Gosselin RA (2012) Achieving locked intramedullary fixa-tion of long bone fractures: technology for the developing world. Int Orthop 36:2007–2013
Zirkle LG, Shahab F (2016) interlocking intramedullary nail without fluoroscopy. Orthop Clin 47:57–66
Ikem IC, Ogunlusi JD, Ine HR (2007) Achieving interlocking nails without using animage intensifier. Int Orthop 37:487–490
Ikepeme I, Ngim N, Udosen A, Obiora O, Okokon E, Segun B (2011) External Jig-aidedintramedullary interlocking nailing of diaphyseal fractures: experience from atropical developing centre. Int Orthop 35:107–111
Guifo ML, Muluem OK, Farikou I, Ngongang FO, Tekpa B, Ndoumbe. (2016) Enclouage centromédullaire verrouillé sans amplificateur de brillance au CHU de Yaoundé: à propos de 34 cas. Revue de chirurgie orthopédique et traumatologique. 102: 101-6
Bombah FM, Mohamadou GE, Nana T, Ekani BY, Danwang C, Guifo ML (2021) Outcomes of closed interlocking intramedullary nailing of the tibia without fluoroscopy in resource-limited settings: experience from two hospitals in Cameroon. Pan Afr Med J 38:87
Sekimpi P, Okike K, Zirkle L, Jawa A (2011) Femoral fracture fixation in developpingcountries: an evaluation of the surgical implant generation network (SIGN) intramedullary nail. J Bone Joint Surg Am 93:1811–1818
Niyondiko JC, Ndayizeye G, Havyarimana C, Mbonicura A, Karayuba R (2016) Enclouage centromédullaire type « SIGN» : Un traitement des fractures adapté aux conditions africaines. Afr J Orthop Trauma 1(1):46–51
Barnes D, McDowell D (2010) Outcomes of long bone fractures treated by open intramedullary nailing at the St Ann’s Bay Hospital. Jamaica West Indian Med J 59(5):540–544
Atiq G, Satar A, Inam M (2012) Treatment of long bone fractures with surgical implant generation network (sign) nail. RMJ 37(2):176–178
Khan I, Javed S, Khan GN, Aziz A (2013) Outcome of intramedullary interlocking SIGN nail in tibial diaphyseal fracture. J Coll Physicians Surg Pak 23(3):203–207
Liao JC, Hsieh PH, Chuang TY, Su JY, Chen CH, Chen YJ (2003) Mini-open intramedullary nailing of acute femoral shaft fracture: reduction through a small incision without a fracture table. Chang Gung Med J 26(9):660–668
Giri SK, Adhikari BR, Gurung GB, Rc D, Bajracharya AR, Khatri K (2008) Mini-open reduction and intramedullary interlocking nailing of fracture shaft of tibia without an image intensifier. Nepal Med Coll J 10(2):123–125
Sah R, Bin LK, Sharma SC, Nepali A (2019) Management of distal tibial metaphyseal fractures with the sign intramedullary nail in Nepal: a retrospective study. IJSIT 8(2):432–440
Naeem-Ur-Razaq M, Qasim M, Khan MA, Sahibzada AS, Sultan S (2009) Management outcome of closed femoral shaft fractures by open surgical implant generation network (sign) interlocking nails. J Ayub Med Coll Abbottabad 21(1):21–24
White NJ, Sorkin AT, Konopka G, McKinley TO (2011) Surgical techique: static intramedullary nailing of the femur and tibia without intraoperative fluoroscopy. Clin Orthop Relat Res 469:3469–3476
Stephens KR, Shahab F, Galat D, Anderson D, Whiting PS, Lundy DW, Zirkle LG (2015) Management of distal tibial metaphyseal fractures with the SIGN intramedullary nail in 3 developing countries. J Orthop Trauma 29(12):469–475
Caubere A, Demoures T, Choufani C, Huynh V, Barbier O (2019) Utilisation de l’enclouage centromédullaire en situation sanitaire dégradée: expérience du service de santé des armées français. Revue de Chirurgie Orthopédique et Traumatologique 105(1):97–101
Ouyang H, Xiong J, Xiang P, Cui Z, Chen L, Yu B (2013) Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis. J Shoulder Elbow Surg 22(3):387–395
Modabber MR, Jupiter JB (1998) Operative management of diaphyseal fractures of the humerus. Plate versus nail. Clin Orthop Relat Res 347:93–104
Moss JP, Bynum DK (2007) Diaphyseal fractures of the radius and ulna in adults. Hand Clin 23(2):143–151
Seyni SB, Thomazeau H, Alhassane AWM, Zirbine AS (2018) Peut-on enclouer les fractures ouvertes récentes du tibia? Expérience du CHU de Lamordé de Niamey (Niger). Revue de Chirurgie Orthopédique et Traumatologique 104(8):837–841
Uruc V, Ozden R, Dogramacı Y, Kalacı A, Dikmen B, Yıldız OS, Yengil E (2013) The comparison of freehand fluoroscopic guidance and electromagnetic navigation for distal locking of intramedullary implants. Injury 44(6):863–866
Kempf I, Grosse A, Taglang G, Favreul E (1993) Le clou gamma dans le traitement àfoyer fermé des fractures trochantériennes. Résultats et indications à proposd’une série de 121 cas. Rev Chir Orthop 79:29–40
Borel JC, Dujardin F, Thomine JM, Biga N (1993) Enclouage verrouillé des fracturescomplexes de la diaphyse fémorale de l’adulte. À propos de 68 cas. Rev ChirOrthop 79:553–64
Pintore E, Maffulli N, Petricciuolo F (1992) Interlocking nailing for fractures of the femur and tibia. Injury 23(6):381–386
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Freddy Mertens Bombah: Conceptualization, data curation, writing-original draft
Florent Anicet Lékina: Conceptualization, writing-review and editing
Daniel Handy Eone: Writing-review and editing
Patrick Dakouré: Editing and supervision
An Sermon: Editing and supervision
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Bombah, F.M., Lékina, F.A., Eone, D.H. et al. Focus on interlocking intramedullary nailing without fluoroscopy in resource-limited settings: strategies, outcomes, and outlook. International Orthopaedics (SICOT) 46, 115–124 (2022). https://doi.org/10.1007/s00264-021-05208-w
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DOI: https://doi.org/10.1007/s00264-021-05208-w