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

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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 7
Figure 9 Figure 10 Figure 11 Nail Insertion The nail is held in a Cannulated T-Handle Inserter (M21897). Align the horizontal bar of the T-Handle and the curved tip of the nail in the same plane. This will enable you to identify the position of the curved tip as it is passed along the medullary canal. Pass the nail through the entry hole with the curved tip pointing downwards. Once in the medullary canal rotate the curved tip so that it is pointing in the direction in which the nail is to be passed (Figure 9). Drive the nail up the canal by rotating the the T-Handle Inserter back and forth. Avoid using a mallet to force the passage of a nail which has become stuck as a secondary fracture may occur. Advance the nail to the fracture site (Figure 10). With a mallet, lightly tap the nail across the fracture taking care not to rotate the tip as this may cause the nail to slip behind or in front of the opposite fragment. Advance the nail towards the metaphysis and anchor it into the cancellous bone (Figure 11). Advance the second nail using the same backward and forward movements. Do not rotate the second nail through a full 360˚ as this may result in the second nail wrapping itself round the first nail. Again tap the nail across the fracture site and advance it towards the metaphysis and anchor it into the cancellous bone. 8
Page 1: P r o d u c t S u r g i c a l R a t
Page 4 and 5: Clinical Results Case 1 Case 2 Case
Page 6 and 7: Nail Selection Nail diameter and le
Page 10 and 11: Figure 12 Figure 13 Figure 14 Final
Page 12 and 13: Forearm Fractures Paediatric forear
Page 14: Ordering Details Nancy Nail Instrum

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

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