Are there any advantages in using a distal aiming device for tibial nailing? Comparing the Centro Nailing System with the Unreamed Tibia Nail

IntroductionThe distal locking of an intramedullary tibial nail can be challenging and time consuming when performed freehand. This study was conducted to evaluate if a distal aiming device would reduce surgical time.Materials and methodsA case-controlled study was performed between 2007 and 2009 with 30 patients receiving a reamed tibial nail (Centronail) with the use of a distal aiming device and 30 patients who were treated with an Unreamed Tibia Nail (UTN), with freehand distal locking, in the same period. The primary outcome in this study was operative time. Secondary outcomes were the need for fluoroscopy, time to consolidation and complications.ResultsOperation time was longer in the Centronail group compared with the UTN group (126 min vs. 96 min, p = 0.000). Use of fluoroscopy for distal locking was needed in half of the cases (n = 16) using a distal aiming device. No differences were found regarding time to consolidation, time to removal of the nail and complications.ConclusionThe use of an aiming device for distal locking of a tibia nail lengthens operation time rather than reducing it. Fluoroscopy was still needed in about half of the cases. No difference was seen in clinical outcomes. The use of a distal aiming device to lock a tibial nail appears to have no benefit.