Application of correction leverage technique in primary failure of distal locking screw during antegrade femoral intramedullary nailing

He Zhiyu; Wan Zhihong; Huang Yu; Liu Anming; Wu Jiaqi; Wang Guoyou; Zhang Lei; Chen Xiaojun

doi:10.12307/2026.206

Abstract：BACKGROUND:Interlocking intramedullary nail fixation is the"gold standard"for the treatment of femoral shaft fractures,and the difficulty of distal locking nail implantation has always been a difficult problem to solve. OBJECTIVE:By comparing the clinical effects of correction leverage technique and free-hand locking nail technique,it is further explained whether the correction leverage technique can be fast and accurate.The distal locking screw of femoral intramedullary nail was placed without direct X-ray radiation exposure,so as to solve the difficulty of distal locking screw placement. METHODS:A total of 52 patients with femoral shaft fractures who experienced difficulty in distal locking screw placement during femoral interlocking intramedullary nail fixation at the Department of Orthopedics,Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University between July 2022 and September 2024 were enrolled.Participants were randomly divided into two groups according to the implantation scheme:the correction leverage group(n=26)underwent the compression bar technique,while the freehand locking nail group(n=26)received conventional freehand locking screw placement for distal femoral intramedullary nail fixation.The distal locking screw placement time,X-ray projection times and first distal screw placement accuracy were compared between the two groups. RESULTS AND CONCLUSION:(1)The distal locking nail placement time in the correction leverage group was significantly shorter than that in the freehand locking nail group(t=-4.136,P<0.001),with a statistically significant difference.(2)The number of X-ray fluoroscopies in the correction leverage group was less than that in the freehand locking nail group(t=-19.696,P<0.001),with a statistically significant difference.(3)In terms of the accuracy of the first nail placement in both groups,the correction leverage group(100%)was higher than the freehand locking nail group(71%),with a statistically significant difference(x2=5.253,P<0.05).(4)The results show that the correction leverage technique has the advantages of fast nail locking,high accuracy,and low X-ray radiation compared with pure freehand nail placement.This technique does not require other auxiliary equipment and is highly maneuverable.Further clinical validation is warranted for its widespread application in femoral shaft fracture fixation with interlocking intramedullary nailing.