This study compares two techniques for the placement of interlocking screws in lower extremity orthopedic nails. With a freehand technique, the surgeon takes a sequence of X-rays before placing a screw to confirm the alignment of the screw’s path based on the appearance of the screw holes of the nail. With a targeting device-based technique, the surgeon attaches a device to one end of the nail after it is inserted and takes X-rays to confirm its alignment with the nail. Once aligned, the targeting device can then be used to insert screws on the nail’s far end without needing further X-rays until all screws are placed. During surgery, participants in this study will have interlocking screws placed with either the freehand or targeting device-based technique. Both techniques and the targeting device are approved by the U.S. Food and Drug Administration (FDA), with previous studies of the targeting device showing decreased operative time and X-rays taken when used in certain settings. Researchers will evaluate the time taken and the number of intraoperative X-rays needed for successful screw placement with each technique.