A novel technique of interlocking screw placement after missing a screw hole

Interlocking nailing has become the common method of treatment of most diaphyseal fractures of long bones today (Brumback et al. in J Bone Joint Surg A 70:1453-1462, 1988; Winquist et al. in J Bone Joint Surg [Am] 66:529-539, 1984). Interlocking screws at the end of the nail that is free of the jig is usually done free hand, by perfect circle technique. Recently, computer-guided interlocking of the nail at the far end of the jig has been introduced, and this technique decreases the radiation and the time for locking at the far end. In fact, it completely avoids radiation while locking at the distal end of the nail (Tornetta et al. in Distal locking using an electromagnetic field guided computer based real time system, San Diego, CA, 2009). Trying to drill without obtaining perfect circles is one of the common causes of missing a screw hole during interlocking nailing, and this is mostly due to inexperience, making small skin incisions, thick fascia causing walking of the drill bit while drilling or being overconfident (Brumback in Tech Orthop 16:342-348, 2001). Further localization of the correct hole is often made difficult by the drill bit trying to re-enter the previously drilled hole. We describe a technique to aid in finding the appropriate screw hole after missing a hole.