sub trochanteric fractre nailing in lateral position
DESCRIPTION
Sub Trochanteric femoral fractures are difficult to operate on a orthopaedic table due to the strong muscles causing flexion, abduction and external rotation of the proximal fragment. It can be operated easily on a simple table in lateral position. Here are some slides showing the tips for such fracture surgery.TRANSCRIPT
Surgery of Surgery of SUB TROCHANTERIC SUB TROCHANTERIC
FRACTURESFRACTURESon simple tableon simple table
Dr. B. Shivashankar.Iyer Orthopaedic Centre, Solapur
President 2008-09National Association of Interlocking Surgeons
ISO 9001:2008Certified Hospital
Ordinary Table
•Either•Radio Lucent – C arm compatible
•Radio Opaque – C arm IITV Non compatible
Hip AP Position of C ArmOn Ordinary Non Radio Lucent Table
Lateral Hip Position for C Arm
On Ordinary Non Radio Lucent Table
Hip abducted and made way for X ray beam
C arm position for Hip AP view
On Ordinary Radio Lucent Table
C arm Position for Cross Table hip lateral View
On Ordinary Radio Lucent Table
X Ray tube under the table, Image intensifierNear the operative hip to avoid too much zooming
C arm Pictures of Hip in Cross Table lateral view
Both hips seen, the one nearer the X ray tube (underneath table)will be magnified, the operative side hip will be seen comparatively smaller as the Camera is nearer to same, confirmed by Passing Steinmann pin passed into the pirifiormis fossa of operative hip. For Doing PFN Pass an anteversion Guide wire parallel to anterior cortex as marked with the arrow in next slide.
C arm Picture of Hip in Cross Table lateral view
Anteversion Guide wire
For Doing PFN Pass an anteversion Guide wire Parallel to anterior cortex as marked with the arrow in the slide and keep the jig parallel to the same while passing guide wires for neck fixation as shown on right.
Advantage – When surgeon inserts Guide Pin, he need not have to get out of the way just for C Arm pictures, He can manipulatethe Guide pin to best position!(seen here)IITV for Hip Lateral View IITV for Hip AP View
C arm monitor is towards foot end of the table . Surgeon, Assistant and the X ray technician, all of them can see the picture
Cross Table Lateral ViewSee the normal B and Operative side A (enlarged as the hip is nearerTo X ray tube underneath)
BA
Passing Anteversion Pin placed very anteriorly in the neck
Passing the anteversion pin AP
Passing Anteversion Pin placed very anteriorly in the neckFinal position- note it is parallel to anterior cortex marked with arrow
Entry with Guide PinNote entry medial to tip of Trochanteralmost from piriformis fossa
Guide pin in lateral viewNote it is in the centre of neck
Advancing the guide pinParallel to anterior cortex in lateral view
Advancing the guide pinParallel to lateral cortex in AP view
Enlarging the entry with centering Awl
Passing the beaded Guide Wire for reaming
Sequential Reaming with flexible reamers
Passing the nail and final seating
Inferior Cervical screw Guide Wire Passingafter making entry with a sharp Awl marked with an arrow
Superior Derotational screw Guide Wire Passingafter making entry with a sharp Awllmarked with an arrow
Both Guide Wires passedAs seen in AP view
Nail Blocking the view of Guide Wires in Lateral View, But both anterior and posterior cortex of the neck seen
By rotating the jig along with anteversion Guide wireGuide wires in the neck can be seen.Please do not rotate only the jig, that will causeBending of the guide wires, Rotate along with anteversionGuide wire to control the rotation of proximal fragment
First drill and pass superiorDerotation Screw
Then drill and pass Cervical screw
Final AP with jig in situ
Flex the knee to enable heel to touch ischeal tuberosity toAlign fragments rotationally correct and then do distal locking by free hand. Proximal jig not removedTo hold and keep the nail hole perpendicular to ground
Drill at the distal end of oblong hole to availDynamisation possible and pass distal IL Bolt
Final AP
Final Cross table lateral
Pre and immediate post operative Xrays
X ray at 6 weeks on 4-11-2011
Few More Cases
28 Year Male
Function at 8 Weeks
14-02-2011
ST fracture with Brachial Plexus ST fracture with Brachial Plexus InjuryInjury
30-1-2009
28-4-200913-3-2009
Scar of Nailing Scar of Nerve Graft donor site
Video Clip on You Tube
• Short Video Clip of 3.2 minutes on You Tube is available as
http://www.youtube.com/watch?v=o2v-ewedvWQ
Copy paste above link on your browser
Thank you
Any Query:
Contact: [email protected]
Dr. B. Shivashankar. Iyer Orthopaedic Centre
An ISO 9001 : 2008 Certified Hospital103, Railway Lines
SOLAPUR 413001, MaharashtraINDIA
Disclaimer• For educational purpose only for
use by Medical students and Orthopaedic Surgeons.
• View expressed are personal• If copied for presentation purpose
kindly give credit to the author.• No financial interest involved• Any Query Contact : Dr. B. Shivashankar on