Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients Using a Lateral Trochanteric Entry Portal.

Abstract

We describe rigid intramedullary nailing using a trochanteric entry for internal fixation of femoral shaft fractures in older children and adolescents. Appropriate preparation prior to the operation is key to minimizing intraoperative and postoperative complications. A well-positioned incision will facilitate and reduce difficulty with ideal guidewire placement. Ensure that the guide pin is properly positioned on the greater trochanter, while avoiding the piriformis fossa. Prepare the definitive guidewire. Insert the guidewire into the proximal fragment via the trochanteric portal. While maintaining the fracture reduction, advance the guidewire into the distal fragment. Pay careful attention to the amount of reaming as well as distraction across the fracture site to provide the best fit for the nail. Be sure to maintain the reduction while advancing the nail across the fracture site. Reconfirm that traction has been reduced to avoid distraction at the fracture site. Use the interlocking screws to secure the proper rotational alignment. Confirm the reduction and adequate fixation before closure. In our original study, a cohort of 246 femoral shaft fractures among 241 skeletally immature patients treated with trochanteric entry rigid intramedullary nailing was retrospectively reviewed.IndicationsContraindicationsPitfalls & Challenges.