J R Rether1, D Höntzsch. 1. Sektion für Traumatologie, Berufsgenossenschaftliche Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland, jrether@bgu-tuebingen.de.
Abstract
OBJECTIVE: Antegrade femoral nailing through a greater trochanteric entry portal avoids damage to the proximal external rotators and to the ramus profundus of the medial femoral circumflex artery, furthermore eases insertion in adipose subjects. However a helical nail shape is necessary for this pathway because bending in two perpendicular planes has to be passed by the nail. INDICATIONS: All femoral shaft fractures suitable for antegrade nailing (type 32-A/B/C). Additional femoral neck fractures (type 31-B) by using proximal Recon-interlocking screws. CONTRAINDICATIONS: The common contraindications for femoral nailing. In certain subtrochanteric fractures (Type 32-A/B) the proximal femoral nail may be favorable. SURGICAL TECHNIQUE: General or spinal anesthesia. Supine position with flexion/abduction of the contralateral leg in order to facilitate fluoroscopy of the proximal femur in a true lateral view. Closed reduction of length and axis. Measurement of length and diameter of the nail using a radiolucent ruler. Dorsolateral approach to the greater trochanter. Insertion of the guide wire 10 mm lateral to the trochanteric tip (anteroposterior view) and in the middle third of the trochanter (lateral view). Reaming of the insertion point using a flexible reamer. If reaming of the entire medullary canal is desired, this should be done using a long intramedullary guide wire in combination with a long flexible reamer. Insertion of the nail starts in an anterior position and ends in a lateral position of the insertion instrument, so a 90° external rotation of the nail occurs during insertion. Proximal interlocking is performed using the guide of the insertion instrument. Check interfragmentary rotation. Distal interlocking using a radiolucent drill device. POSTOPERATIVE MANAGEMENT: Depends on the fracture shape: stable interfragmentary support may allow early full weight bearing. Otherwise, reduced weight bearing is recommended for at least 6 weeks. RESULTS: In a prospective mulicentric study, 227 helical femoral nails were used for antegrade femoral nailing. Follow-up after 12 month was available in 74 %. Surgeons' rating for ease of identifying entry site was excellent or good in 89 %. Functional and radiological results after 12 months do not prove significant benefits over conventional antegrade femoral nails.
OBJECTIVE: Antegrade femoral nailing through a greater trochanteric entry portal avoids damage to the proximal external rotators and to the ramus profundus of the medial femoral circumflex artery, furthermore eases insertion in adipose subjects. However a helical nail shape is necessary for this pathway because bending in two perpendicular planes has to be passed by the nail. INDICATIONS: All femoral shaft fractures suitable for antegrade nailing (type 32-A/B/C). Additional femoral neck fractures (type 31-B) by using proximal Recon-interlocking screws. CONTRAINDICATIONS: The common contraindications for femoral nailing. In certain subtrochanteric fractures (Type 32-A/B) the proximal femoral nail may be favorable. SURGICAL TECHNIQUE: General or spinal anesthesia. Supine position with flexion/abduction of the contralateral leg in order to facilitate fluoroscopy of the proximal femur in a true lateral view. Closed reduction of length and axis. Measurement of length and diameter of the nail using a radiolucent ruler. Dorsolateral approach to the greater trochanter. Insertion of the guide wire 10 mm lateral to the trochanteric tip (anteroposterior view) and in the middle third of the trochanter (lateral view). Reaming of the insertion point using a flexible reamer. If reaming of the entire medullary canal is desired, this should be done using a long intramedullary guide wire in combination with a long flexible reamer. Insertion of the nail starts in an anterior position and ends in a lateral position of the insertion instrument, so a 90° external rotation of the nail occurs during insertion. Proximal interlocking is performed using the guide of the insertion instrument. Check interfragmentary rotation. Distal interlocking using a radiolucent drill device. POSTOPERATIVE MANAGEMENT: Depends on the fracture shape: stable interfragmentary support may allow early full weight bearing. Otherwise, reduced weight bearing is recommended for at least 6 weeks. RESULTS: In a prospective mulicentric study, 227 helical femoral nails were used for antegrade femoral nailing. Follow-up after 12 month was available in 74 %. Surgeons' rating for ease of identifying entry site was excellent or good in 89 %. Functional and radiological results after 12 months do not prove significant benefits over conventional antegrade femoral nails.
Authors: J R Rether; J M Muñoz Vives; H J Bail; M H Verhofstad; M Blauth; J Ljungqvist; D Höntzsch Journal: Unfallchirurg Date: 2013-07 Impact factor: 1.000
Authors: Michael C Tucker; John R Schwappach; Ross K Leighton; Kevin Coupe; William M Ricci Journal: J Orthop Trauma Date: 2007-09 Impact factor: 2.512
Authors: Michael Archdeacon; Kevin R Ford; John Wyrick; Mark V Paterno; Shelley Hampton; Mary Beth Ludwig; Timothy E Hewett Journal: J Orthop Trauma Date: 2008-01 Impact factor: 2.512