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

Introduction: 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: Appropriate preparation prior to the operation is key to minimizing intraoperative and postoperative complications.

Step 2 Perform Incision And Exposure: A well-positioned incision will facilitate and reduce difficulty with ideal guidewire placement.

Step 3 Place And Overream The Guide Pin: 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: 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: 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: 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: Use the interlocking screws to secure the proper rotational alignment.

Step 8 Make Final Images And Close The Wound: Confirm the reduction and adequate fixation before closure.

Results: 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.