Free-hand distal locking of intramedullary nails: How to quickly achieve perfect circles without specific instrumentation.

INTRODUCTION: Intramedullary locked nails are mainly used for the fixation of mid-shaft fractures in the long bones. But inserting the distal locking screws by the free-hand technique may require high exposure to radiation. Our method achieves perfect circles on radiographs on the first attempt for lower limb fractures without any specific instrumentation. SURGICAL TECHNIQUE: We applied a geometric principle in which two lines perpendicular to another line are parallel to each other. Proximal locking, whether it is done or not, serves as a guide for the first perpendicular line to the nail. The fluoroscopy unit is aligned along the drill sleeve or the screwdriver left in place to achieve perfect circles on the first attempt. DISCUSSION: This technique is simple, reliable, and reproducible. It does not require any specific instrumentation, allows the surgeon to choose any manufacturer's nail and reduces the operating room staff's exposure to radiation.

Mycobacterium setense sp. nov., a Mycobacterium fortuitum-group organism isolated from a patient with soft tissue infection and osteitis.

A Gram-positive, rod-shaped acid-fast bacterium was isolated from a patient with a post-traumatic chronic skin abscess associated with osteitis. Morphological analysis, 16S rRNA, hsp65, sodA and rpoB gene sequence analysis, cell-wall fatty acid and mycolic acid composition analyses and biochemical tests showed that the isolate, designated ABO-M06(T), belonged to the genus Mycobacterium. Its phenotype was unique and genetic and phylogenetic findings suggest that strain ABO-M06(T) represents a novel species within the Mycobacterium fortuitum group. The name Mycobacterium setense sp. nov. is proposed for this novel species, with the type strain ABO-M06(T) (=CIP 109395(T)=DSM 45070(T)).