• OBJECTIVES
    • To compare the free-hand (FH) technique of placing interlocking screws to a commercially available electromagnetic (EM) targeting system in terms of operating time, radiation dose, and accuracy of screw placement.
  • METHODS
    • Between September 2011 and July 2012, we prospectively randomized 100 consecutive femur shaft fractures in 99 patients requiring intramedullary nails to either FH using fluoroscopy (n = 43) or EM targeting (n = 38; Sureshot).
  • SETTING
    • Single Level 1 University Hospital Trauma Center.
  • MAIN OUTCOME MEASUREMENTS
    • The 2 groups were assessed for distal locking with respect to time, radiation, and accuracy.
  • RESULTS
    • Eight-one fractures had data accurately recorded (38 EM/43 FH). The average total operative time was 50 minutes (range, 25-88 minutes; SD, 13.9 minutes) for the FH group and 57 minutes (range, 40-103 minutes; SD, 16.12 minutes) for the EM group. The average time for distal locking was 10 minutes (range, 4-16 minutes; SD, 3.56 minutes) with FH and 11 minutes (range, 6-28 minutes; SD, 10.24 minutes) with EM. Average radiation dose for distal locking was significantly less (P < 0.0001) for EM at 230.54 μGy (range, 51-660 μGy; SD, 0.17 μGy) compared with 690.27 μGy (range, 200-2310 μGy; SD, 0.52 μGy) for FH. There were 2 misplaced drill bits in FH and 3 in EM. This was not statistically significant (P = 0.888).
  • CONCLUSIONS
    • The electromagnetic targeting device (Sureshot) significantly reduced radiation exposure during placement of distal interlocking screws, without sacrificing operative time, and was equivalent in accuracy when compared with the FH technique.
  • LEVEL OF EVIDENCE
    • Therapeutic level II.