Thigh Bone Fractures: Repair With a Bone Nail and Screws Animation

Thigh Bone Fractures: Repair With a Bone Nail and Screws Animation

This video will demonstrate 2 similar surgical treatments for thigh bone fractures, also known as femoral shaft fractures, using a bone nail and screws. Bone nails are also called intramedullary nails. These are metal rods that sit within the center portion of the bone, called the medullary canal. They are often locked in place with screws which aid in providing internal stability and support to a healing bone. They may be inserted either through the top of the thigh bone, near the hip, or the bottom of the thigh bone, near the knee.

Most often, nails are placed through the top of the thigh bone. However, putting the nail through the bottom of the thigh bone may be preferred because of the patient’s individual anatomy or situations where there are other injuries to the top of the thigh bone, such as a hip fracture. This video will demonstrate both approaches, beginning with the more common option through the top of the thigh bone. Here is a left femur. An incision will be made on the side of the hip to access the top of the femur. A soft-tissue protector will be introduced and placed on the femur, at the tip of a portion of the bone called the greater trochanter.

Then a temporary wire will be introduced at the same point and drilled into the center of the femur. This wire serves as a guide for the drill that will be used to make a path for the incoming nail. The inner sleeve of the soft-tissue protector will be removed. Then, an instrument called an entry reamer, which has a cutting tip at the end, will bore a starting hole in the bone. All instruments will be removed. A longer temporary wire will be brought into the shaft of the femur. The placement of this wire is important as it serves as the pilot position for the nail. The length of this wire will be measured, which will determine the length of the nail needed.

The soft-tissue protector will be brought in. Then, another reamer will be brought into the canal of the femur over the wire. Again, this reamer tip will cut through the bone, creating a hole and path for the nail. This will be repeated with progressively larger reamer tips until the hole is the right size for the nail. Then a nail that is slightly smaller than the hole will be carefully malleted into place. Attached to the end of the nail is a guide, which the surgeon will use to place screws from the outside of the body that correspond perfectly with the holes in the nail. A drill and drill guide will be used to make a hole for a screw which will help lock the nail in place.

The hole will be measured, and a screw will be placed. This process will be repeated for several screws in different directions to provide the best stability of the nail. The guide will then be removed. Once the screws are inserted in the top of the nail, screws will be inserted in the base of the nail at the bottom of the thigh bone. As before, a hole will be drilled, measured, and then a screw will be placed. Each screw that is placed, will require a small incision. Once complete, the incisions will be closed, and the surgery is now complete.

Here is a right femur. The surgeon will make an incision to the front of the knee, just below the kneecap. The knee will be flexed in surgery to access the bottom of the femur bone. Like the other technique, a soft-tissue protector, guide pin, and reamer will be used to make a carefully planned entry hole in the bone. A guidewire will be introduced into the femur's shaft, followed by measurements to determine the nail's length. As before, cutting reamer tips will gradually increase the path down the center of the bone for the incoming nail. Again, the nail will be placed over the wire and malleted into place. The wire will be removed.

As before, an attached guide will be used to place screws, this time at the end of the femur near the knee. The screw that is placed across the base of the thigh bone has a nut and washers to help improve the fixation of the hardware. This is used when a fracture occurs between the 2 rounded ends of the bone. Additional screws will be placed in the nail using the guide and drill. The screws are designed to be placed in various directions to assist with the stability of the nail. Finally, as with the other placement option, screws may be placed at the end of the nail for further stability. The guide will be removed, and all incisions will be closed. The surgery is now complete.