3
Determine nail length
Position the image intensifier for an AP view of the distal
femur (Position 1). With long forceps, hold the Radiographic
Ruler (357.122) parallel to and on the same level as the femur.
Adjust the ruler until the distal end is at the desired nail inser-
tion depth. Mark the skin laterally.
Move the image intensifier to the proximal femur (Position 2),
place the distal end of the ruler on the skin mark, and take
an AP image of the middle third of the femur (for short nails)
and of the proximal femur (for long nails). Verify fracture
reduction and read the nail length from the ruler image. When
using a long nail, select its length so that it can be locked level
with the lesser Trochanter.
4
Careful preoperative planning with clear classification of the
fracture and correct choice of implants are mandatory for a
successful surgical result.
1
Position patient
Position the patient supine on the operating table. The knee
of the injured leg should be flexed 70°–90°. A leg roll may be
used or the lower leg be flexed by lowering part of the table
to allow proper reduction and stabilization of the reduced
fracture. Position the image intensifier in such a way that vi-
sualisation of the entire femur is possible in anterior-posterior
(AP) as well as lateral views.
2
Reduce fracture
If possible, carry out closed reduction under image intensifier
control. In some cases the use of the Large Distractor (394.350)
is required.
Note:
After repositioning, and prior to the insertion of the
nail, intra-articular fractures should be definitely stabilised with
two interfragmentary lag screws. Position the screws so as not
to interfere with the path of the nail. The intramedullary canal
and the nail are slightly dorsal, therefore, lag screws are placed
ventrally.
Distal Femoral Nail
Standard locking
Position 1
Position 2
