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Femoral Shaft Frx: Leg Lengths / Nail Lengths

- Measurement of Length:
    - its essential to plan ahead to achieve proper leg length;
    - w/ comminuted frx, use opposite leg to determine leg length;
    - one method is to obtain long cassette radiograph of opposite side w/ radiographic ruler included on the film;
            - note that if a ruler is not included in the film, then the x-ray is worthless (may be off by as much as 4 cm);
    - alternatively, apply a radiolucent ruler over the normal thigh after the patient has been positioned on the frx table;
            - note that the ruler should be positioned on the side of the thigh rather than on top of it (otherwise there will be an underestimation of leg length);
            - the ruler should measure from the tip of the greater trochanter to the top of the patella (or epiphyseal scar);

- Technique Pearls:
    - once proper leg length has been determined, it is important to stick with the measured nail length, rather than compressing the
            fracture ends which can lead to gross shortening at the frx site;
    - the nail is driven into the distal fragment to the appropriate depth and then the distal interlocking screws are inserted;
            - subsequently traction is applied while the nail continues to be driven in with the slap hammer until the proximal end of the nail reaches the greater trochanter

Assessing Leg Length After Fixation of Comminuted Femur Fractures