Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients Using a Lateral Trochanteric Entry Portal.

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.