Distal Femoral Nail
Standard locking
Synthes
15
Oval (incorrect)
Round (correct)
Determine
incision point
Proximal locking
Proximal locking for nails of 160 – 240 mm in length is done
using two Locking Bolts
4.9 mm which are inserted later-
ally. Nails of 300 mm or more are provided with a static hole
in lateral direction, and a static hole and a dynamic locking
slot in AP direction. These locking options make immediate or
secondary dynamization of the fracture possible. The AP
approach facilitates locking at the lesser trochanter level.
Align image
Check fracture reduction, the correct alignment of the
fragments, and the correct length of the femur.
Align the image intensifier so that the distal hole is visible as
a perfect circle in the centre of the image.
16
Make incision
Determine the incision point and make a stab incision.
17
Drill
Under image intensification, insert the tip of the Drill Bit
4.0 mm for the radiolucent drive through the incision
and place it on the bone.
Tilt the drive until the drill bit appears centred in the locking
hole. The drill bit will nearly fill out the locking hole image.
Holding the drill in this position, drill through both cortices
until the tip of the drill bit just penetrates the medial cortex.
Alternative
If there is no radiolucent drive available and locking is
performed with the standard freehand technique use the
three-flute Drill Bit
4.0 mm (315.400).
Centre drill bit
Drill
15
