Guide wire centralization for femoral nailing: A novel technique to improve alignment and reduce radiation

Abstract Objectives: Femoral shaft fractures are frequently managed with intramedullary nailing, where central guide wire placement is vital for optimal alignment and implant positioning. Despite various reduction techniques, literature lacks a stepwise method for consistent guide wire centralization in femoral nailing. We aim in this study to describe a maneuver in centralizing the guidewire thus reducing the radiation exposure and surgical time. Materials and Methods: A prospective study was conducted from January 2018 to January 2023 on 60 patients with nailable femoral shaft fractures using a novel guide wire centralization technique. The technique involved controlled manipulation of a 2.8 mm bent guide wire using a T handle to align it accurately in the distal femoral notch with reduced reliance on intraoperative fluoroscopy. Results: The average time for guide wire centralization among six surgeons was 5.02 min, with a mean of 8.18 C-arm shots per procedure. This demonstrated a notable reduction in operative time and fluoroscopic exposure compared to traditional methods, suggesting improved efficiency, and reproducibility.