Carbon Fiber Implant for Fixation of a Pathologic Subtrochanteric Fracture
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Massachusetts General Hospital
Procedure Outline
Table of Contents
- 1. Introduction
- 2. Open Bone Lesion Biopsy of the Right Proximal Femur Through Lateral Subvastus Approach
- 3. Second Incision for Insertion of Nail into the Proximal Femur
- 4. Provisional Reduction with Schanz Pins Under Fluoroscopy
- 5. Placement of Starting Wire in Proximal Fragment
- 6. Opening Reamer over Starting Wire
- 7. Reduction with Finger Reduction Tool
- 8. Ball-Tip Guidewire Insertion
- 9. Measurement for the Length of the Nail
- 10. Sequential Reaming over Ball-Tip Guidewire
- 11. Exchanging the Ball-Tip Guidewire for a Smooth Wire that Fits Through the Carbon Fiber Implant
- 12. Carbon Fiber Implant Placement over Smooth Wire
- 13. Guidewire Insertion for the Femoral Neck Screw Trajectory Using the Aiming Arm and the Triple Trocar
- 14. Measurement for the Length of the Femoral Neck Screw
- 15. Triple Reamer and Femoral Neck Screw over Guidewire
- 16. Setting Screw Proximally on the Nail
- 17. Confirming Position on AP and Lateral Views of the Hip and Knee
- 18. Blocking Screws for Distal Nail
- 19. Final Confirmation of Positioning on AP and Lateral Views
- 20. Copious Irrigation
- 21. Hemostasis and Closure
- 22. Post-op Remarks
- Pre-op CT of the Right Pelvis and Femur
- Position the C-arm to Match the Position of the Leg to Avoid Disturbing the Reduction
- Gain Access to Distal Femur
- Use Two Drills Left in Place to Help Guide Second Trajectory
- Measure for the Length of the First Screw
- Place First Screw
- Measure for the Length of the Second Screw
- Place Second Screw