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Interlocking Screw Insertion

Brumback, Robert J. MD


Summary All orthopaedic surgeons trained in the past 20 years are familiar with interlocking intramedullary nails. Refinements in the materials and the designs of these devices, coupled with a widespread availability of the equipment required for their insertion, have led to the assumption that the majority of orthopaedists are facile with this procedure. For many surgeons, the most demanding part of interlocking nailing remains the placement of interlocking screws by the freehand method. This frustration, including concerns over radiation exposure, creates a lack of confidence in this part of the procedure, possibly affecting a surgeon’s decision to stabilize with dynamic or static intramedullary fixation. Failure to appropriately interlock unstable injuries can lead to malunion from postoperative shortening and malrotation. 1 The purpose of this article is to provide tips and suggestions that may facilitate the insertion of interlocking screws via the freehand technique for the femur and tibia.

From The Department of Orthopaedic Surgery, Union Memorial Hospital, and the R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland at Baltimore.

Address correspondence and reprint requests to Robert J. Brumback, MD, c/o Lyn Camire, Editor, Union Memorial Orthopaedics, The Johnston Professional Building, #400, 3333 North Calvert Street, Baltimore, MD 21218; e-mail:

© 2001 Lippincott Williams & Wilkins, Inc.