Surgical Technique for Femur Nail - ARZZT

Direct vision surgical approach:
Make an incision in the lateral side middle line with post lateral approach depending
fracture height, dissect by planes following the intramuscular septum up to the femur,
retracting soft tissues in anterior direction to minimize quadriceps damage, after exposing
the fracture, pull and pull out the distal fragment, rhyme the fragment one millimeter
greater than the nail chosen by the Orthopedic Surgeon, make the same procedure in the
proximal fragment.
Insert the guide through the shaft to proximal, cross the trochanter until it is subcutaneous,
flex the hip and make an incision where the guide pressure appears, remove the tip, in
blunt form dissect until obtaining enough space for the nail insertion, perform fracture
reduction and insert the guide and the intramedullary nail, remove the guide and proceed
to distal locking and subsequently to proximal locking, perform this in case you are using a
cannulated nail. When using a solid nail, guide is only removed to guide and direct nail
insertion in the proximal side.
Close vision surgical approach:
Patient is place with fracture reduction and fluoroscopy control in the fracture table, perform
a oblique incision from greater trochanter proximal extreme to proximal and medial
direction about 8 cm long, dissect by planes in blunt form through gluteus maximums fascia
following fibers direction, in depth piriformis or digital fossa, insert trochanter (Awl), all
under image intensifier view.
Incision Trochanter base (Awl) Patient Position
Insert a guide up to femur distal side, insert
intramedullary reamer progressively by
hand form or mechanical drill up to
inserting the reamer one millimeter
greater than the diameter chosen by the
Orthopedic Surgeon.
Check reduction and measure nail length
requirement, insert the nail until it is
completely inserted up to trochanter edge,
remove guide and proceed to place the
guide to locate the different holes, drill and
screw placement.
4