Hip Fractures: Repair With a Bone Nail and Screws Animation

Hip Fractures: Repair With a Bone Nail and Screws Animation

This video will provide an animated demonstration of a hip fracture repair using a bone nail and screws. Hip fractures can occur in various patterns and locations at the top of the femur, or thigh bone. In this demonstration, a bone nail and screws will be used for a specific type of fracture called an intertrochanteric fracture. This hip fracture lies between the 2 bony projections at the top of the femur, called the greater and lesser trochanters. Here is a left femur with the ball being at the top of the bone.

To access the top of the femur, an incision will be made on the side of the hip. An instrument called a soft-tissue protector will be placed on the greater trochanter. This instrument protects the nearby muscles from the instruments used in the surgery. This location will serve as the starting point for the nail. A guidewire will be drilled into the central portion of the femur shaft. X-rays will verify the placement. Then, an instrument called an entry reamer with 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 essential as it serves as the pilot position for the nail. The length will be measured to determine the length of the nail needed. 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. A nail slightly smaller than the hole will be gently malleted into the bone. The guidewire is removed.

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 unique screw called a lag screw will now be placed through the guide. Before the screw is placed, a guidewire will be inserted. The position of the wire will be checked with an x-ray and then its depth will be measured. A drill will be inserted over the wire to make a hole for the screw. The lag screw will be brought in over the wire and inserted to the proper depth. This screw has a telescoping head that allows for even more compression after surgery to help heal the fracture.

As the fracture heals, this prevents the screw from pushing out the side of the femur, which can lead to complications such as pain on the outside of the hip. Speaker1: The screw will be engaged to compress the fracture site. The black handle will then be turned to lock the screw into place. The nut on the end of the handle will be removed so the screwdrivers can be freed. A rod that is still engaged with the screw will be removed along with the original guidewire. A small blue sleeve will then be removed, which releases the telescoping head of the screw.

Another screw will be placed lower to further lock the implant into place. A small incision will be made on the outside of the leg to advance the guide further towards the bone. The inner sleeve of the guide will be removed. A drill will make a hole through the bone. The hole will be measured and a screw will be placed. All remaining guides will be removed. All hardware is now in place and the incisions will be closed.

After the surgery, the nail and screw continue to work hard. The fracture and telescoping lag screw are shown immediately post-up, meaning after surgery. As the fracture heals, the telescoping lag screw helps further compress the break without pushing the screw out of the bone, which assists with optimal healing.