Application of TINAVI orthopedic robot-assisted proximal interlocking screw placement for femoral retrograde intramedullary nails: a retrospective clinical study.

Retrograde intramedullary nailing is a common treatment for middle and lower femoral fractures where proximal locking is the main challenge. This study explored the application and experience of robot-assisted retrograde intramedullary nail proximal precision locking. Data from 74 patients with middle and lower femoral fractures treated with retrograde intramedullary nails between January 2021 and June 2023 were retrospectively analyzed. According to the different proximal locking methods, the data were divided into a robotic group (34 cases) and a free-hand group (40 cases). General, perioperative, and follow-up data of the two groups were collected, and their differences were compared based on specified parameters. The results are as follows: the mean follow-up time was (16.10 ± 2.38) months, the number of screw placements in the robotic group (1.03 ± 0.17) was less than that in the manual group (1.63 ± 1.15, P = 0.004), and the number of fluoroscopies (1.06 ± 0.34) was significantly less than that in the manual group (6.35 ± 2.46, P < 0.001). Additionally, the total length of the proximal incision (2.16 ± 0.24) was shorter than that in the manual group (3.58 ± 0.38, P < 0.001), and the success rate of one-time screw placement (97.1%, 33/34) was significantly higher than that in the manual group (67.5%, 27/40; P = 0.001). There were no significant differences in the other indices of the two groups (P > 0.05). For the treatment of the middle and lower femoral fractures using a femoral retrograde intramedullary nail, the robotic navigation system is more efficient than traditional manual nail placement under fluoroscopy because it can shorten the number of proximal locking nail placements, the number of fluoroscopies, and the total length of the proximal incision. Additionally, it can reduce the exposure to external radiation and increase the success rate of one-time nail placement. Thus, this study presents a novel approach for the placement of proximal interlocking screws in femoral retrograde intramedullary nails, making it worthy of clinical application.