P r o d u c t R a t i o n a l e S u r g i c a l T e c h n i q u e - Biomet

Surgical Technique
Femoral Fractures
Paediatric femoral fractures are typically treated with two nails inserted in a retrograde
fashion from medial and lateral entry portals located above the epiphysis. Very distal
fractures should be treated with an antegrade approach.
Positioning and Fracture Reduction
The patient is positioned on an orthopaedic traction table (Figure 6). An image
intensifier is positioned so that it can be rotated to obtain AP and lateral views. It
should also be possible to visualise the whole femur from the knee to the hip joint.
The entire thigh including the knee is prepared as an operative field. External
manipulation is conducted until adequate reduction is obtained and confirmed by
flouroscopy.
Figure 6
Approach
Make a 2 cm skin incision distally to the required entry hole to provide access for the
instruments, and to prevent any trauma to the skin (Figure 7). You may start either
on the medial or the lateral side. An oblique drill hole is made 2 - 4 cm above the
growth plate by applying a careful angulation movement of the drill bit until the
entry hole is at an angle of at least 60˚ with the axis of the medullary canal (Figure 8).
Make the the entry hole slightly larger than the diameter of the chosen nail.
Figure 7
Figure 8
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