Retrograde reaming of the femur Fig. Thoroughly irrigate the knee joint after retrograde reaming of the femur, to remove any debris. Use new grommet for each surgery.
The five openings define three passageways 26, 27, 28 including two upwardly oblique passageways 26, 27 for femoral repairs and one downwardly oblique passageway 28 for recon repairs. There are a variety of devices used to treat femoral fractures.
Subtrochanteric and femoral shaft fractures have been treated with the help of intramedullary nails which are inserted into the marrow canal of the femur to immobilize the femur parts involved in fractures.
An angled cross-nail or locking screw is inserted through the femur and the proximal end of the intramedullary rod. In some varieties, one or two screws may also be inserted through the femoral shaft and through the distal end of the intramedullary nail. The standard intramedullary nails have been successfully employed in treating fractures in lower portion of the femoral shaft.
Fractures of the neck, head or trochanters of the femur have been successfully treated with a variety of compression screw assemblies which include generally a compression plate having a barrel member, a lag screw and a compressing screw. The compression plate is secured to the exterior of the femur and the barrel member is inserted into a predrilled hole in the direction of the femoral head.
The lag screw which has a threaded end and a smooth portion is inserted through the barrel member so that it extends across the break and into the femoral head. The threaded portion engages the femoral head. The compressing screw connects the lag screw to the plate.
By adjusting the tension of the compressing screw the compression reduction of the fracture can be adjusted.
The smooth portion of the lag screw must be free to slide through the barrel member to permit the adjustment of the compression screw.
A number of patents to Brumfield, and the assignee of this application relate to intramedullary nail prothesis assignee of this application relate to intramedullary nail prothesis with transverse and diagonally extending bone screws including U.
Patents 4,, 5,, and 5, The axes of the pairs of holes intersect to provide a left or right orientation for insertion of a single locking screw. The screw is designed to pass from the greater to the lesser trochanter. There is not sufficient mechanical support to allow usage of the locking screw in the direction towards the femoral head because the second pair of holes weaken the nail when loaded in that direction.
Further, the locking screw is a fully threaded screw which does not permit sliding of the screw relative to the intramedullary rod.
Compression screw assemblies are shown by the following patents: The Blosser and Wagner patents illustrate the use of multiple screws to prevent rotation of the lag screw relative to the compression plate and barrel member. A surgical bone pin which functions like a lag screw and compressing screw but which does not include a compression plate is known by Cochran et al.
A British patent GB 2,A discloses an intramedullary nail for setting broken long bones. The nail has a head, a shank and a tip portion provided with an open ended groove for engaging a bolt previously inserted into the bone transverse to the bone axis to secure the nail to the bone.
The Mareno patent 4, discloses an intramedullary nailing assembly that is adapted to the internal fixation of comminuted femoral fractures, which combines a conventional femoral nail, and extension and a set of pins interlocked with the nail and its extension.
The extension is designed to be inserted into the proximal end of the femoral nail, and is predrilled to accept pins, some of which extend obliquely onto the femoral neck. A drill guide which can be inserted in the proximal end of the extension provides a convenient tool for predrilling the femur at the proper places and at the proper angles.
The nail itself can be predrilled to receive pins on a bench mounted drilling guide. The Chapman patent discloses a modular femoral fixation system for use in the treatment of femoral disorders resulting from injury, disease, or congenital defects.
The apparatus includes at least three interconnectable components: Preferably, many or all of these components of the system are made of an inner, resilient titanium base alloyed.
The Grosse-Kempf nail manufactured by Howmedica Company of Rutherford, New Jersey is believed to be one of the earliest intramedullary nailing devices introduced into the United States.
The Grosse-Kempf nail includes a threaded hole in the intramedullary rod for receiving the interlocking screw. The fully threaded cannot slide through the threaded hole to permit the type of compression found in the compression screw assemblies discussed above.
Furthermore, the axis of the threaded hole coincides with a line between the greater to lesser trochanter and not in the direction of the femoral neck. The Zickel nail is a solid intramedullary nail having a single proximal tri-flange cross-nail which is inserted in the direction of the femoral head.
The intramedullary rod is curved in two planes to mimic the shape of the femur. The solid cross section does not permit insertion over a guide rod, thus preventing the use of the Zickel nail for comminuted and distal fractures of the femur because the closed surgical technique cannot be practiced.
The rigid tri-flange cross-nail is not suitable for use in treating femoral neck fractures because the cross-nail must be locked into position by a set screw to prevent backing out.
Adequate compression cannot be achieved. As stated above, the sliding compression screw has been found to be most effective in treating femoral neck fractures. The commercially available Kuntscher Y-nail includes a flanged cloverleaf shaped intramedullary nail which is inserted through a hole in a single femoral neck nail.
The rod includes a longitudinal slit.Stryker Osteosynthesis has a market leadership position in the Intramedullary (IM) Hip Screw market due to the minimally invasive nature of the Gamma Nail. In , Stryker launched a new version of the Gamma Nail that can be implanted through an even smaller incision.
Currently, antegrade intramedullary nailing and minimally invasive plate osteosynthesis (MIPO) represent the main surgical alternatives in distal tibial fractures.
However, neither choice is optimal for all bony and soft tissue injuries. The Retrograde Tibial Nail (RTN) is a small-caliber prototype implant, which is introduced through a 2-cm-long incision at the tip of the medial malleolus.
DEPUY SYNTHES SOLUTIONS • Support of biological osteosynthesis even in the case of complex fractures and osteoporosis. a fixed-angle construct to an intramedullary nail. Therefore, it combines the advantages of angular stability and a minimally invasive approach.
Most of the orthopedic implants, materials, and devices evaluated for MRI issues (i.e. magnetic field interactions, heating, and artifacts) are made from nonferromagnetic materials and, therefore, are safe or “MR Conditional” according to the conditions specified for patients undergoing MR procedures.
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