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Background  It is challenges for surgeon to position the distal locking screw of a tibia intramedullary nail. The traditional free-hand (FH) technique is related to the proficiency of surgeons and has a long learning curve. Furthermore, the radiation dose and the accuracy of screw placement should be taken into account. The new technology, the electromagnetic navigation system (ET), which is a radiation-free way to locate the position of the drill bit. The purpose of our study is to evaluate the results of the ET for distal locking screw of a tibia intramedullary nail and to compare the effects with the FH technique.    Methods  Eighty-nine cases of tibia diaphyseal fracture who needed to treat by intramedullary nails were analyzed retrospectively, and were divided into 2 groups. Patients in navigation group (n = 54) were treated with intramedullary nail using the ET for distal locking, while other 35 patients using FH technique. Intraoperative fluoroscopy exposure times, screw insertion times, and healing times were recorded. The parameter was used for comparison in 2 groups.    Results  The mean time of distal locking in the ET technique was significant less than that in the FH group (5.89 ± 2.02 minutes vs 12.26 ± 4.40 minutes) and the exposure time was reduced in ET group significantly (2.13 ± 0.73 seconds vs 19.09 ± 10.41 seconds). The healing time was proved to be coincident in FH group and ET group (15.34 ± 2.98w vs 16.06 ± 3.74w). The one-time success rate of distal locking nail operation was 100% in the navigation group, which was significantly higher than that in FH group ( P  < .05).    Conclusion  Compared with the FH technique, the ET for distal locking of tibia intramedullary nail has the advantages of high efficiency and short locking time without radiation.

Comparison of free-hand fluoroscopic guidance and electromagnetic navigation in distal locking of tibia intramedullary nails