Surgical Technique - Innovative Medical Products

US Patent No. 6,309,396B1
G. David Ritland, M.D.

The Femur Finder ® is designed
to direct the guide wire into
the medullary canal. Do not
use it to manipulate the
fracture fragments, reduce the
fracture, or direct the guide
wire across the fracture site.
INTRODUCTION
The Femur Finder ® System is used in the
management of femur fractures suitable for
closed antegrade rodding. The technique
requires less than a two centimeter incision
to introduce the guide wire into the
medullary canal. It can be used when the
entry point is at either the piriformis fossa or
the greater trochanter. The surgeon does
not need to expose the neck or trochanter of
the femur by deep dissection. With this
system, introduction of the guide wire is a
percutaneous procedure. This reduces the
operative time required to place the guide
wire. There is less weakening of the abductor
muscles, postoperative morbidity, and pain.
Guide Tube
Handle
Figure 1
Guide Rod
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DESCRIPTION
The Femur Finder (IMP #198) is made of
stainless steel. It directs the guide wire into
the medullary canal. It has three components
as shown in Figure 1.
1. The guide tube is curved to allow the
beveled tip to align on the femur neck
tangent to the center line of the canal and
place the entry point in the skin proximal
and lateral to the tip of the greater
trochanter. The beveled point will slide
through the skin, subcutaneous fat, tensor
fascia and abductor muscles with minimal
dissection. The point itself solidly locks
into the bone with hand pressure and
prevents the guide wire from “walking”
as it is drilled through the cortex.
2. The guide rod is a visual aid for aligning
the path of the guide wire to the femur
center line. The long portion of the guide
rod is parallel to the path the guide wire
takes as it exits the tip. The rounded end
marks the end of the guide tube bevel as
shown by the perpendicular line to be a
visual aid for estimating the depth of
penetration.
3. The handle allows one handed
manipulation of the guide tube as it is
advanced toward the femur.

ROOM SET-UP AND
PATIENT POSITIONING
1. Position the patient supine with the
ipsilateral arm flexed at the shoulder and
the forearm supported over the chest.
Traction and positioning of the legs is at
the surgeons discretion.
2. The surgeon stands at the patient’s
shoulder facing the foot of the table. Set
the video display so that the proximal
femur image is at the BOTTOM of the
screen and the distal femur is at the TOP
(Fig. 2). This will assure that the right-left
motion of the tip of the Femur Finder
correlates with the right-left motion of its
silhouette on the screen. All of the
drawings in this protocol are oriented in
this manner so the surgeon can become
familiar with this view.
3. Proceed with skin prep and drape of
choice.
Figure 2
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LOCATING THE INCISION
Left Side of Monitor
MONITOR
Distal
Right Side of Monitor
Left Side of Monitor
MONITOR
Distal
Right Side of Monitor
1. Apply traction to the leg and make
preliminary adjustments to reduce the
fracture.
2. From an AP view of the hip mark an “X”
on the anterior thigh directly over the
image of the piriformis fossa. Place a
straight edge on the thigh passing through
the “X” estimating the center line of the
femur. Draw a center line on the anterior
thigh from the “X” to the fracture site
(line A, Fig. 3A). This locates the center
of the medullary canal in the parasagittal
plane.
3. Draw a line from the “X” perpendicular to
the anterior center line around laterally on
the thigh (line B, Fig. 3A).
4. Change to a lateral view and draw another
line, as in step one, to mark the center line
in the lateral plane (line C, Fig. 3B). Extend
this line proximally to the iliac crest
5. Start the incision on the lateral centerline
about 12 centimeters proximal to this
intersection point with line B. Incise
through the skin and subcutaneous fat
down to the tensor fascia. Split the fascia
and abductor muscles a bit to allow entry
of the tissue protector. Insert the IMP
Tissue Protector (#198-TP) into this tract.
Bend the wings on the Tissue Protector to
conform to the thigh (Fig. 4). Clip them to
the drapes to keep the Tissue Protector in
place for the rest of the procedure. It will
protect the muscle from shredding by the
reamers.
Proximal
Figure 3A
Proximal
Figure 3B
Figure 4
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IMP 3mm sterile guide wires (IMP
198-GW) are designed for use with
the Femur Finder. The spade tip is
shaped so it will not scrape on the
curved lumen and release metal
chips. Other brands of guide wires
do not have this feature. Always
use a new straight guide wire. Do
not use a guide wire that is bent.
Even if the bent wire can be forced
into the lumen as it rotates it will
rub and metal particles will be
worn off the guide wire.
INSERTING THE FEMUR
FINDER ® AND GUIDE WIRE
1. While the surgeon proceeds with the above
steps the scrub tech can load the power
drill with a new IMP sterile 3mm guide
wire (IMP #198-GW). Insert it so the
etched band at the center of the wire is just
exposed at the jaws of the chuck. This
assures there will be enough wire
protruding forward to penetrate ten
centimeters into the femoral canal when
the chuck is bottomed out on the Femur
Finder.
2. Guided by an AP view of the femur
centered on the piriformis fossa, insert the
Femur Finder through the Tissue Protector
and advance it towards the estimated
location of the piriformis fossa. As a visual
aid, align the guide arm parallel with the
two center lines so the exiting guide wire
will be tangent to the femur center line
(Fig. 5). Hold pressure against the bone to
prevent losing position of the bevel point.
For the trochanteric approach to IM nailing
use the same technique except locate the
point of the Femur Finder so the guide
wire is centered on the tip of the greater
trochanter.
Figure 5
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Do not hammer the Femur
Finder ® into the bone. Do not
insert the Femur Finder into
the femur to try to manipulate
the bone to reduce the fracture.
This instrument is not designed
for that purpose. There is
danger of splitting a fragment
off the trochanter.
3. Remember: For a right femur fracture the
lateral view will show the anterior surface
of the femur on the left side of the screen
and the posterior surface, (lesser
trochanter) on the right side of the screen
(Fig 3B, Fig 5). For a left femur fracture
the lateral view will show the anterior
surface of the femur on the right side of
the screen and the posterior surface, (lesser
trochanter) on the left side of the screen.
4. Verify the point location in both views.
Maintain the point pressed against the
bone with one hand and, with the other
holding the power drill, slide the guide
wire into the Femur Finder and advance it
without rotating the drill until it emerges
from the bevel and pushes against the
femur (Fig. 6). Then start the power drill
and drill the guide wire into the bone.
Because the Femur Finder point is locked
on the bone the guide wire tip will not tend
to “walk” as it tries to get a ”bite” on the
slanted surface of the bone. Be sure to
maintain the alignment of the guide wire
on the center line as it advances.
5. Advance the guide wire until the chuck
contacts the Femur Finder. Holding the
guide wire in place at its proximal end,
remove the power drill. Extract the Femur
Finder. Careful! Don’t pull out the guide
wire too.
6. Done! The Femur Finder has done its job.
7. Proceed in the surgeon’s chosen manner
to advance the guide wire and reduce the
fracture.*
8. Insert the exchange tube and replace the
guide wire with the ball tip guide wire
(IMP#198-BT). Proceed with opening the
canal and reaming in customary manner.
Figure 6
* The Ducharme Fracture Alignment Device (Cat. # 701) from
IMP aids in reduction of the fracture.
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FEMUR FINDER ®
STERILIZATION PROCEDURES
Hi-Vac Sterilization:
1. Proper cleaning of the instrument is necessary. Ensure cannula of the
Femur Finder is thoroughly cleaned with the specially designed IMP
cleaning brush (Cat. # 399). Thoroughly wash and decontaminate the
instrument.
2. Double wrap Sterilization Case (Cat. # 198-Case) containing Femur Finder
and Tissue Protector with CSR wrap.
3. Run normal vacuum cycle for your institution. Minimum recommended
parameters are:
Time: 4 minutes exposure
Temperature: 270° F (132° C)
Pressure: 30 PSI
Drying Time: 20 minutes
Cool at room temperature
Flash Cycle:
1. Minimum recommended cycle parameters for Sterilization Case containing
Femur Finder and Tissue Protector unwrapped are:
Temperature: 272° F (133° C)
Time: 4 minute exposure
Cool at room temperature
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Innovative
Medical Products, Inc.
US Patent No. 6,309,396B1
Femur Finder is a registered trademark of Innovative Medical Products, Inc.
6029 .2M ©2006 Innovative Medical Products, Inc. All rights reserved. 1/07
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