Introduction We describe rigid intramedullary nailing using a trochanteric entry for internal fixation of femoral shaft fractures in older children and adolescents.
Step 1: Preparation Prior to Incision Appropriate preparation prior to the operation is key to minimizing intraoperative and postoperative complications.
Step 2: Perform Incision and Exposure A well-positioned incision will facilitate and reduce difficulty with ideal guidewire placement.
Step 3: Place and Overream the Guide Pin Ensure that the guide pin is properly positioned on the greater trochanter, while avoiding the piriformis fossa.
Step 4: Place the Guidewire and Reduce the Fracture Prepare the definitive guidewire. Insert the guidewire into the proximal fragment via the trochanteric portal. While maintaining the fracture reduction, advance the guidewire into the distal fragment.
Step 5: Measure Nail Length and Begin Overreaming Pay careful attention to the amount of reaming as well as distraction across the fracture site to provide the best fit for the nail.
Step 6: Insert the Nail Be sure to maintain the reduction while advancing the nail across the fracture site. Reconfirm that traction has been reduced to avoid distraction at the fracture site.
Step 7: Insert Proximal and Distal Interlocks Use the interlocking screws to secure the proper rotational alignment.
Step 8: Make Final Images and Close the Wound Confirm the reduction and adequate fixation before closure.
Results In our original study, a cohort of 246 femoral shaft fractures among 241 skeletally immature patients treated with trochanteric entry rigid intramedullary nailing was retrospectively reviewed.
Pitfalls & Challenges
We describe rigid intramedullary nailing using a trochanteric entry for internal fixation of femoral shaft fractures in older children and adolescents.
Femoral shaft fractures are a common injury among children and adolescents. A variety of treatment options exist to address this injury. Flexible intramedullary nailing may be the ideal …
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