Carbon Fiber Implant for Fixation of a Pathologic Subtrochanteric Fracture

1. Introduction

1. Pre-op CT of the Right Pelvis and Femur

2. Open Bone Lesion Biopsy of the Right Proximal Femur Through Lateral Subvastus Approach

3. Second Incision for Insertion of Nail into the Proximal Femur

4. Provisional Reduction with Schanz Pins Under Fluoroscopy

5. Placement of Starting Wire in Proximal Fragment

6. Opening Reamer over Starting Wire

7. Reduction with Finger Reduction Tool

8. Ball-Tip Guidewire Insertion

9. Measurement for the Length of the Nail

10. Sequential Reaming over Ball-Tip Guidewire

11. Exchanging the Ball-Tip Guidewire for a Smooth Wire that Fits Through the Carbon Fiber Implant

12. Carbon Fiber Implant Placement over Smooth Wire

13. Guidewire Insertion for the Femoral Neck Screw Trajectory Using the Aiming Arm and the Triple Trocar 

14. Measurement for the Length of the Femoral Neck Screw

15. Triple Reamer and Femoral Neck Screw over Guidewire

16. Setting Screw Proximally on the Nail

17. Confirming Position on AP and Lateral Views of the Hip and Knee

18. Blocking Screws for Distal Nail

1. Position the C-arm to Match the Position of the Leg to Avoid Disturbing the Reduction
2. Gain Access to Distal Femur
3. Use Two Drills Left in Place to Help Guide Second Trajectory
4. Measure for the Length of the First Screw
5. Place First Screw
6. Measure for the Length of the Second Screw
7. Place Second Screw

19. Final Confirmation of Positioning on AP and Lateral Views

20. Copious Irrigation

21. Hemostasis and Closure

22. Post-op Remarks