Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner

This research investigates complex fracture treatment, focusing on optimizing rapid and precise guidewire insertion techniques during intramedullary nailing for intertrochanteric femoral fractures. We present a protocol for the assessing the guidewire of intramedullary femoral nailing in obese patients using an in-house designed awl. The newly designed guide awl with the distal positioner could reduce the difficulty in opening the femur for inserting the interlocked intramedullary nail. We will focus on developing an integrated care rehabilitation support platform for frail elderly with rehabilitative potential.

[Instructor] To begin, position the patient supine on a radiolucent table. Place the contralateral limb in an adjustable leg holder. Now drape the patient for a standard femoral nail procedure. Using iodine povidone, disinfect the surgical field longitudinally from the costal margin to the foot, and transversely from the anterior midline beyond the posterior spine. Then, place four sterile towels on specific anatomical areas, and secure them with towel clips or adhesive drapes. Extend the sterile field with middle sheets, and center a large fenestrated drape over the hip. Now cover the distal limb using a sterile stockinette, and secure with an elastic bandage. Perform open reduction of the comminuted fracture fragments, and assemble the guidance device. Next, make a longitudinal skin incision approximately three to five centimeters long, two to three centimeters proximal to the trochanteric apex, extending along the femoral shaft axis. Using a scalpel, dissect through the gluteus medias fascia, and palpate the tip of the greater trochanter to confirm location. After aligning the entry point with the trochanteric tip, place the tip of the awl at the marked entry point. Make a small incision at the distal position tube. Insert a three millimeter wire, and confirm K-wire tip location. Advance the wire to offset proximal femur valgus, and confirm extension into the medullary cavity. Insert a 2.5 millimeter guide wire through the awl to a depth of around 15 centimeters, and confirm position under image intensifier. Tap the awl gently with a hammer to open cortex, and keep tip aligned with lesser trochanter. Next, attach the nail to the handle and tighten with torque wrench. Insert the nail, ensuring the proximal tip aligns with the greater trochanter, and the distal gap is 10 to 20 millimeters. After verifying fracture reduction, insert guidewire and confirm position for proximal blade or screw. Finish with distal locking. The patients were treated with locking intramedullary nailing with the help of a newly designed guide apparatus or conventional guide apparatus. The mean operation time in the newly designed guide group was around 45.8 minutes, which was less compared to the mean operation time of 58 minutes in the conventional guide group. The intraoperative blood loss in the newly designed guide group was 104 milliliters, and 122.8 milliliters in the control group. The success rate of the one-time inserted guide wire was 100% in the newly designed guide group, and the radiation times were less. There was no significant change in bone healing time between the two groups.