Cost-Saving Innovation: Talon Distal Locking Speeds Up Humeral Nailing
Keywords:
humeral fracture, intramedullary nailing, distal locking, talon, operative time, fluoroscopy, cost, surgical efficiencyAbstract
Background: Humeral fractures are common and increasing due to an aging population. Intramedullary nailing is less invasive than plating. Traditionally, distal locking is achieved with screws placed under fluoroscopy. Newer nails feature internal talons, reducing the number of operative steps.
Purpose: This study compares operative and fluoroscopy times between standard screw (SS) and talon distal-locking (TF) systems for intramedullary nailing of humeral fractures.
Methods: This is a retrospective comparative study of 99 humeral fractures treated with intramedullary nailing by three orthopaedic trauma surgeons at a single Level II regional trauma center (2017–2021). Polytrauma patients undergoing simultaneous procedures were excluded. Operative time (from anesthesia records) and fluoroscopy time (from C-arm dose reports) were compared between groups using multivariate analysis of variance (MANOVA).
Results: Thirty-nine standard screw (SS) and 60 talon fixation (TF) humeral nail cases were analyzed. The TF group had significantly shorter operative time than the SS group (53.32 ± 17.92 vs 64.62 ± 16.74 minutes; mean difference 11.30 minutes; 95% CI 4.17–18.43; p = 0.002). Fluoroscopy time was lower in the TF group but did not differ significantly (90.88 ± 43.12 vs 99.83 ± 41.52 seconds; p = 0.309). The operative-time reduction corresponds to an estimated ~$618 per case.
Conclusions: Talon distal locking was associated with an 11-minute reduction in operative time versus interlocking-screw fixation, with comparable fluoroscopy time, suggesting potential intraoperative efficiency and cost benefits. Clinical outcomes were not assessed; a prospective, multicenter study is warranted.
Level of Evidence: Level III; Retrospective Comparative Study
Keywords: humeral fracture; intramedullary nailing; distal locking; talon; operative time; fluoroscopy; cost; surgical efficiency
References
REFERENCES
Eisenberg, G., Otremski, H., Segev, E., et al. (2022). Rethinking conservative treatment of humeral diaphyseal fractures in elderly patients with dementia. Journal of Orthopaedic Trauma, 36(12), 634–638. https://doi.org/10.1097/BOT.0000000000002434
Duparc, F. (2013). Malunion of the proximal humerus. Orthopaedics & Traumatology: Surgery & Research, 99(1 Suppl), S1–S11. https://doi.org/10.1016/j.otsr.2012.11.006
U.S. Census Bureau. (2018, March 13). Older people projected to outnumber children for first time in U.S. history (Release No. CB18-41). https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html
Naso, C. M., Lin, S. Y., Song, G., & Xue, H. (2025). Time trend analysis of osteoporosis prevalence among adults 50 years of age and older in the USA, 2005–2018. Osteoporosis International, 36(3), 547–554. https://doi.org/10.1007/s00198-025-07395-3
Lewiecki, E. M., Ortendahl, J. D., Vanderpuye-Orgle, J., Grauer, A., Arellano, J., Lemay, J., Harmon, A. L., Broder, M. S., & Singer, A. J. (2019). Healthcare policy changes in osteoporosis can improve outcomes and reduce costs in the United States. JBMR Plus, 3(9), e10192. https://doi.org/10.1002/jbm4.10192
Gallusser, N., Barimani, B., & Vauclair, F. (2021). Humeral shaft fractures. EFORT Open Reviews, 6(1), 24–34. https://doi.org/10.1302/2058-5241.6.200033
Pogliacomi, F., Malagutti, G., Menozzi, M., Colacicco, A., Ceccarelli, F., Vaienti, E., & Calderazzi, F. (2020). Antegrade intramedullary nailing in proximal humeral fractures: Results of 23 cases. Acta Biomedica, 91(4-S), 209–216. https://doi.org/10.23750/abm.v91i4-S.9650
Hudson, P. W., Gulbrandsen, M. T., Liu, J. N., Ponce, B. A., & Phipatanakul, W. P. (2022). Percutaneous intramedullary nailing of complex humeral shaft fractures: A retrospective case series. Cureus, 14(12), e32999. https://doi.org/10.7759/cureus.32999
Ouyang, H., Xiong, J., Xiang, P., Cui, Z., Chen, L., & Yu, B. (2013). Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: An updated meta-analysis. Journal of Shoulder and Elbow Surgery, 22(3), 387–395. https://doi.org/10.1016/j.jse.2012.06.007
Hossain, M., Abdullah, S., & Saad, S. (2025). A comparison of plate fixation and intramedullary nailing in shaft of humerus fractures in adult. EAS Journal of Orthopaedic and Physiotherapy, 7(1). https://doi.org/10.36349/easjop.2025.v07i01.002
Lam, A., Hoyt, B. W., Allsbrook, A., & Andersen, R. (2022). Intramedullary nailing of humerus fractures using an implant system with internal distal locking and avoiding distal incisions: Operative and clinical outcomes. Journal of Surgical Orthopaedic Advances, 31(1), 12–16.
Box, M. W., Stegelmann, S. D., Domingue, G. A., et al. (2024). Intramedullary nail fixation versus open reduction and internal fixation for treatment of adult diaphyseal forearm fractures: A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 19, 719. https://doi.org/10.1186/s13018-024-05158-0
Smith, T., et al. (2022). Cost of OR time is $46.04 per minute. Journal of Orthopaedic Business, 2(4), 10–13. https://doi.org/10.55576/job.v2i4.23
Yoon, A., et al. (2023). Cost of anesthetic supplies and staffing for operative anesthesia is $8.62 per minute. Journal of Orthopaedic Business, 3(3), 17–20. https://doi.org/10.55576/job.v3i3.37
Tyllianakis, M., Tsoumpos, P., Anagnostou, K., Konstantopoulou, A., & Panagopoulos, A. (2013). Intramedullary nailing of humeral diaphyseal fractures: Is distal locking really necessary? International Journal of Shoulder Surgery, 7(2), 65–69. https://doi.org/10.4103/0973-6042.114233
Barış, A., & Öztürkmen, Y. (2021). Comparison of humeral intramedullary nail internal locking system and standard external locking system. Istanbul Medical Journal, 22(4), 250–256. https://doi.org/10.4274/imj.galenos.2021.04695
Akdemir, M., Biçen, Ç., Özkan, M., & Ekin, A. (2021). Comparison of expandable and locked intramedullary nailing for humeral shaft fractures. Cureus, 13(10), e18833. https://doi.org/10.7759/cureus.18833
Guo, Z., Sang, L., Meng, Q., Tian, L., & Yin, Y. (2022). Comparison of surgical efficacy of locking plates and interlocking intramedullary nails in the treatment of proximal humerus fractures. Journal of Orthopaedic Surgery and Research, 17(1), 481. https://doi.org/10.1186/s13018-022-03360-6
Okelana, A. B., McMillan, L. J., Kibble, K., et al. (2019). Variation in implant selection for ankle fractures: Identifying cost drivers. Journal of Orthopaedic Trauma, 33(7), S26–S31. https://doi.org/10.1097/BOT.0000000000001623
Haas, D. A., & Kaplan, R. S. (2017). Variation in the cost of care for primary total knee arthroplasties. Arthroplasty Today, 3(1), 33–37. https://doi.org/10.1016/j.artd.2016.08.001
Erden, T., Kapicioglu, M., Demirtas, A., Bilsel, K., Akpinar, F., & Kuduz, H. (2019). Biomechanical comparison of humeral nails with different distal locking mechanisms: Insafelock nails versus conventional locking nails. Acta Orthopaedica et Traumatologica Turcica, 53(6), 490–496. https://doi.org/10.1016/j.aott.2019.08.003
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sarah Johnson, Shelby Ramsey, Amy Trammell, Romney C. Andersen
This work is licensed under a Creative Commons Attribution 4.0 International License.
