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.IndicationsContraindicationsPitfalls & Challenges.
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.IndicationsContraindicationsPitfalls & Challenges.
Authors: Samuel A Tisherman; Philip Barie; Faran Bokhari; John Bonadies; Brian Daley; Lawrence Diebel; Soumitra R Eachempati; Stanley Kurek; Fred Luchette; Juan Carlos Puyana; Martin Schreiber; Ronald Simon Journal: J Trauma Date: 2004-10
Authors: J Eric Gordon; Todd A Swenning; Timothy A Burd; Deborah A Szymanski; Perry L Schoenecker Journal: J Bone Joint Surg Am Date: 2003-07 Impact factor: 5.284