- IM Nailing Technique:
- Open Femur Frx:
- Radiographs:
- always look for evidence of a pathologic lesion on x-ray, noting that it would be
disasterous if a nail were driven thru an occult osteosarcoma or chondroscaroma;
-
AP pelvis: (rule out concomitant injuries)
-
Hip Dislocation
-
Femoral Neck Frx
-
Lateral of Knee:
- look for knee effusion (as evidenced by anterior displacement of supra-
patellar pouch fat pad) which may indicate knee ligament injury;
-
Leg Lengths:
- w/ comminuted frx it is of paramount importance to achieve equalization
of leg lengths;
- obtain long leg cassette of uninjured leg w/ a radiolucent ruler
included on film;
- long leg cassettes w/o a ruler are notoriously inaccurate;
-
Canal Width:
- in adolescents and young adults carefully assess the width of the
canal at the isthmus on both the AP and Lateral views;
- a tight canal leads can lead to special problems during the case
such as difficulty in reaming, difficulty in reducing the
fracture (and even passing the guide wire across the frx)
- it is important ahead of time to have the proper selection of nails
available, small hand held reamers, and one or more surgical
assistants to help with the reduction;
- since frx reduction will be difficult, skeletal traction is a must,
since it allows the knee to be flexed (which relaxes the
hamstrings and gastrocnemius) which facilitates reduction;
- one method that can be helpful is to first ream the proximal fragment to
the desired canal width;
- subsequently, it will be easier to pass the guide wire across
the fracture site;
- Classification:
- it is necessary to consider frx location and comminution;
-
Comminuted Frx;
- comminution extending proximally or distally to the frx site needs to
be carefully assessed prior to IM nailing;
- preoperative measurements of uninjured femur are needed inorder to obtain
equal
leg lengths postoperatively;
- w/ longitudinal fissures extending away from the frx site, consider open
cerclage wiring prior to IM nailing;
-
Proximal Frx:
-
Distal Frx:
- w/ distal fractures, its essential to obtain perfect nail length since
and nail that is too short may have interlocks at the level of the
frx, and a nail that is too long will end up lying proud above the
greater trochanter;
- Traction:
- Positioning:
- Frx Reduction
- proximal frx:
- Distal Frx:
- Implant Selection (Synthes:
- IM Nail Insertion Technique:
