J Korean Fract Soc.  2011 Jan;24(1):79-82. 10.12671/jkfs.2011.24.1.79.

Lateral Positioning for Proximal Femoral Nailing of the Intertrochanteric Fracture: Surgical Technique

• Lee KH
• Jeong H
• Ha JK
• Kim YJ
• Jang WH

• KMID: 1449421
• DOI: http://doi.org/10.12671/jkfs.2011.24.1.79

Abstract

In the treatment of intertrochanteric fractures, most of intramedullary nailings are performed on a fracture table in supine position. In supine position, however, soft tissue mass of the patients and drapes make it difficult to access to the piriformis fossa and to straighten the trajectory of reamer and nail insertion. To resolve these problems, we have treated twenty intertrochanteric fractures in lateral position on the general operation table with IM nail. Adjustment of the position of lag screw in femoral head was done with the technique that overlaps the shadows of the femoral head, nail and targeting guide in the lateral view. Because the entire injured limb can be moved readily, it was easy to reduce fracture and to convert to open procedure. In cases likely that the fracture table is unavailable in which patients are obese, have short stature or are amputated, and that open procedure is strongly likelihood, lateral position will be helpful technique in the treatment of intertrochanteric fractures with IM nail.

Keyword

Femur; Intertrochanteric fracture; Intramedullary nail; Lateral position

MeSH Terms

Extremities
Femur
Fracture Fixation, Intramedullary
Head
Hip Fractures
Humans
Nails
Operating Tables
Supine Position

Figure

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  Fig. 1 For anteroposterior view, C-arm is rotated under a table. Rolled sheets are placed under knee and ankle of the patient for reduction of fracture.

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  Fig. 2 Lateral view of proximal femur. (A) The shadows of femoral head, nail and targeting guide overlap. (B) Diagram of C-arm view.

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  Fig. 3 Adjustment of the anteversion of lag screw (A) Simulation with saw bones shows that the rotation of targeting guide determines position of lag screw in the femoral head. (B) Corresponding C-arm views show shadows of 3-components, in which contours of targeting guides are outlined with solid line.

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