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The Surgical Technologist
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JANUARY 2015
20
in place, the measuring device will be placed over the guide-
wire, down to the blade guide sleeve. The blade length will
be read directly from the measuring device to the tip of the
guidewire.
The blade guide sleeve will then be removed. The surgi-
cal technologist will chuck up the 11-mm tapered cannulat-
ed drill bit and hand it to the surgeon. The surgeon will pass
the drill bit over the guidewire and drill to the stop, opening
the lateral cortex. While the surgeon is doing that, the surgi-
cal technologist will need to load the 6-mm/10-mm stepped
cannulated drill bit. The stepped drill bit requires the drill
stop. The drill stop will be slide onto the drill bit, and the
surgical technologist will press the button to place the stop
to the measured helical blade length.
The helical blade coupling screw will be placed down the
inserter. The helical blade will be aligned with the inserter
and the coupler screw will be used to secure the blade to
the inserter. The coupler screw will need to be tightened by
hand, and there needs to be emphasis to not overtighten.
The surgical technologist will then hand over the helical
blade assembly with a mallet. Once the helical blade is fully
inserted, the surgeon will need the 5.0-mm flexible hexago-
nal screwdriver to engage the locking mechanism. Once
the helical blade is locked, interfragmentary compression
will be obtained by turning the buttress/compression nut
clockwise by hand. If additional leverage is needed, the 4.5-
mm pin wrench will be used. The coupling screw and the
inserter will be removed, and the surgeon will use the 5-mm
flexible hexagonal screwdriver to loosen the connection and
remove the blade guide sleeve from the aiming arm.
A 4-mm fluted drill bit loaded on a quick release adapt-
er will be needed. The surgeon will insert the assembled tro-
car and sleeves into the aiming arm marked for the locking
screw. He or she will make a small incision using a #15 blade
on a #3 knife handle. The surgeon’s preference will dictate
whether to use a hemostat to dissect to the bone. After the
trocar touches the bone, it will be removed. The surgeon
will then drill for the locking screw. The drill bit will be
calibrated and once it goes through the medial cortex, the
surgeon will advise on the screw length. Otherwise, a mea-
suring device is available to measure the screw. After the
drilling and measuring is complete, the surgeon will advise
of the size and will remove the drill guide, leaving the pro-
tective sleeve in place. The surgeon will insert and tighten
the screw by hand only using the hexagonal screwdrivers –
no power will be used on this screw. The surgeon will then
remove the aiming arm and nail insertion handle by using
the 8 mm ball hexagonal screwdriver.
The end cap is optional. For reverse oblique intertro-
chanteric and high subtrochanteric fractures, the nail will
need to sit slightly proud of the greater trochanter to provide
an added point of fixation. If the nail is over-inserted, the
end cap will be used to add length to the nail to accomplish
the length requirements. The end cap also will be used if
the surgeon is concerned about bony overgrowth into the
proximal end of the nail. The end cap will be cannulated
and inserted over the 3.2-mm guidewire with the guidewire
inserted into the nail. An 11-mm ratchet, 5-mm flexible hex-
agonal screwdriver, 5-mm hexagonal shaft and the 11-mm
hexagonal cannulated socket will be required to insert the
end cap. The surgeon will place the end cap down over the
guidewire and use the ratchet to tighten the end cap.
The surgeon will irrigate the wound with a saline irri-
gation. He or she will use an 0 polyglactin 910 on a CT-1
needle for the facia layer and a 2-0 polyglactin 910 or a
3-0 polyglactin 910 for the subcutaneous layer, followed by
either skin staples or a 4-0 polyglactin 910 on a PS-2 or a 4-0
poliglecaprone 25 on a PS-2 needle for the skin layer. Dress-
ings usually include 4x4 paddings and tape. An adduction
pillow may be used to keep the leg immobolized temporar-
ily. Patients will be admitted for post-operative evaluation
and pain management.
After the surgery, the patient will be evaluated for physi-
cal therapy. The goal is to get the patient as mobile as pos-
sible as quickly as possible.
6,7
Most patients remain hospital-
ized for a week post-op.
The surgeon will insert and tighten the
screw by hand only using the hexagonal
screwdrivers – no power will be used on
this screw. The surgeon will then remove
the aiming armand nail insertion handle by
using the8-mmball hexagonal screwdriver.
