JANUARY 2015
|
The Surgical Technologist
|
19
stays within the canal and there is no distal impingement.
Once the nail passes the fracture site, the guidewire (if used)
should be removed. The surgical technologist will give the
surgeon the appropriate aiming arm, decided upon prior to
the procedure. This will be attached to the insertion handle.
The blade guide sleeve, the buttress/compression nut, the
3.2-mm guidewire and the 11-mm/3.2-mm guidewire will
be used at this point. The buttress/compression nut will be
placed about midway onto the blade guide sleeve. The blade
guide sleeve and the 3.2-mm trocar will be placed onto the
aiming arm with the 3.2-mm guidewire loaded onto a wire
driver. The surgeon will make a small incision at the point
of insertion using either a #10 blade or a #15 blade on a #3
knife handle and dissect the fascia.
The sleeve assembly will be inserted through the soft
tissue to the bone. The buttress/compression nut will snap
into the aiming arm. The buttress/compression nut will need
to be turned counterclockwise to advance the blade guide
sleeve to the bone. The surgeon will use the C-arm imaging
to confirm the blade guide is on the lateral cortex. Fracture
reduction will need to be confirmed by image intensifica-
tion. The surgeon will remove the 3.2-mm trocar, and the
surgical technologist will pass the 3.2-mm guidewire loaded
onto a power guidewire driver. The guidewire will need to
be advanced into the femora head stopping 5 mm from the
subchondral bone. The tip of the guidewire will be placed
where the tip of the helical blade will be. The wire place-
ment should be confirmed in both the AP and lateral views
using the image intensifier. The 3.2-mm guidewire will then
be removed.
Once the placement of the guidewire is confirmed, the
surgeon will measure the length for the helical blade using
the helical blade measuring device. With the guidewire still
The intertrochanteric regions are made
up of the proximal femur distal to the
neck extending to the lesser trochanter.
The majority of the bone in this region
is cancellous, extracapular and highly
vascularized leading to a robust healing
environment.
