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

[Introduction][1] We describe rigid intramedullary nailing using a trochanteric entry for internal fixation of femoral shaft fractures in older children and adolescents. [Step 1: Preparation Prior to Incision][2] Appropriate preparation prior to the operation is key to minimizing intraoperative and postoperative complications. [Step 2: Perform Incision and Exposure][3] A well-positioned incision will facilitate and reduce difficulty with ideal guidewire placement. [Step 3: Place and Overream the Guide Pin][4] Ensure that the guide pin is properly positioned on the greater trochanter, while avoiding the piriformis fossa. [Step 4: Place the Guidewire and Reduce the Fracture][5] 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. [Step 5: Measure Nail Length and Begin Overreaming][6] Pay careful attention to the amount of reaming as well as distraction across the fracture site to provide the best fit for the nail. [Step 6: Insert the Nail][7] 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. [Step 7: Insert Proximal and Distal Interlocks][8] Use the interlocking screws to secure the proper rotational alignment. [Step 8: Make Final Images and Close the Wound][9] Confirm the reduction and adequate fixation before closure. [Results][10] 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. [Indications][11] [Contraindications][12] [Pitfalls & Challenges][13] [Introduction][1] We describe rigid intramedullary nailing using a trochanteric entry for internal fixation of femoral shaft fractures in older children and adolescents. [Step 1: Preparation Prior to Incision][2] Appropriate preparation prior to the operation is key to minimizing intraoperative and postoperative complications. [Step 2: Perform Incision and Exposure][3] A well-positioned incision will facilitate and reduce difficulty with ideal guidewire placement. [Step 3: Place and Overream the Guide Pin][4] Ensure that the guide pin is properly positioned on the greater trochanter, while avoiding the piriformis fossa. [Step 4: Place the Guidewire and Reduce the Fracture][5] 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. [Step 5: Measure Nail Length and Begin Overreaming][6] Pay careful attention to the amount of reaming as well as distraction across the fracture site to provide the best fit for the nail. [Step 6: Insert the Nail][7] 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. [Step 7: Insert Proximal and Distal Interlocks][8] Use the interlocking screws to secure the proper rotational alignment. [Step 8: Make Final Images and Close the Wound][9] Confirm the reduction and adequate fixation before closure. [Results][10] 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. [Indications][11] [Contraindications][12] [Pitfalls & Challenges][13] [1]: #sec-12 [2]: #sec-13 [3]: #sec-14 [4]: #sec-15 [5]: #sec-16 [6]: #sec-17 [7]: #sec-18 [8]: #sec-19 [9]: #sec-20 [10]: #sec-21 [11]: #sec-23 [12]: #sec-24 [13]: #sec-25