Synthes The Titanium Femoral Nail System, Руководство по технике

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Read nail length
Position the ruler
Opening the Femur
Position the patient
Position the patient in the lateral decubitus or supine position,
on a fracture or radiolucent operating table. Use of the Large
Distractor is optional.
Position the C-arm so true AP and lateral views are possible.
Reduce the fracture.
1
Confirm nail length
Position the image intensifier for an AP view of the proximal
femur. With a long forceps, hold the ruler alongside the lateral
aspect of the thigh parallel to and at the same level as the femur.
Adjust the C-arm so the beam is centered between the femur and
ruler; this will prevent magnification errors. Adjust the ruler until
the top is level with the tip of the greater trochanter. Mark the
skin at the top of the ruler.
Move the image intensifier to the distal femur, replace the proximal
end of the ruler at the skin mark, and take an AP image of the
distal femur. Verify fracture reduction. Read nail length directly
from the ruler image, selecting the measurement at or just
proximal to the physeal scar, or at the chosen insertion depth.
2
OPENING
T
HE
FEMUR
15
Identify nail entry point
The entry point for the nail is in line with the medullary
canal in the AP and lateral views. This point is posterior
in the proximal femur, in the piriformis fossa, but varies
with patient anatomy.
Make a longitudinal incision proximal to the greater
trochanter, through the gluteus medius and maximus
interval. Insert the 3.2 mm guide wire through the
incision to the piriformis fossa. Under an AP image
intensification view, center the pin in line with the
medullary canal.
Perform the same procedure under a lateral view.
3
Center the pin in
the AP view
Center the pin in
the lateral view