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Medial condyle
Osteomalacia
Trauma
Osteonecrosis
Osteoporosis
Trochanteric and Condylar fractures often occur in conjunction with Femoral Shaft fractures
Surgeon determines the length of the nail by placing a nail on the lateral side of the leg as an X-ray is taken
Anteroposterior and lateral X-rays
Basic Orthopedic Instrument Set-
Get out:
Basics-
Drill bit box
AO System & Nails
Get Out:
Mallet
Aiming Arm
Triple Trocar Assembly
Guidewire bent with pliers
Reamer
Guidewire
Blade & Local
Drill
Tissue Protector
Insertion Instrument
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3
5
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Using the power drilll, a guide wire is placed into the medullary canal (A), using the C-arm to ensure placement
4
An initiator drill bit with a tissue protector (B) is placed over the guide wire to enlarge the opening. The medullary cavity is reamed out.
The surgeon then inserts the nail, by hand, as far as possible. Then the surgeon then uses a mallet to drive the nail the rest of the way through the femur, and the guide wire is removed.
An incision is made proximal to the greater trochanter
The surgical technologist assembles the insertion instrument with a driving cap (Striking point for mallet) used to place the nail
A
B
Reamer
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Two locking bolts are placed proximal using a hand-held screwdriver, with help of a standard aiming arm attached to the insertion handle with a triple trocar assembly inserted to the bone (Protection sleeve, drill sleeve, and a trocar)
Insertion instruments are removed.
An end cap is screwed onto the proximal end of the nail.
Fluoroscopy is used to create a stab wound over the distal hole in the femoral nail, a depth gauge obtains the bolt length then the bolt is placed using a holding sleeve and screwdriver
*Final count of all softs
The incisions are sutured close.
Dressing: Incisions are covered with 4X4's and wrapped with wrapped with Ace/Coban. The surgeon may use a stent.
Video: https://www.orthobullets.com/trauma/12079/femoral-shaft-fracture-antegrade-intramedullary-nailing