FEMORAL SHAFT [Case 2] · Retrograde Intramedullary Nail

Diaphyseal femur fractures associated with a narrow medullary canal and cortical alterations require precise entry portal planning, strict rotational control, and proper nail placement to prevent mechanical complications.

This training demonstrates the complete execution of retrograde intramedullary nailing osteosynthesis, presented in a full 4K video from the surgeon's perspective, with an emphasis on medullary canal alignment, progressive reaming strategy, rotational correction based on the lateral cortex, and fluoroscopy-guided distal and proximal locking.

TRAINING FOCUS

• Indication for retrograde intramedullary nailing in diaphyseal femur fractures
• Entry portal planning through the patellar tendon
• Patient positioning and surgical table organization
• Guidewire insertion with fluoroscopic control
• Fracture reduction and femoral rotational control
• Progressive reaming of the medullary canal
• Intramedullary nail insertion and proper positioning
• Fluoroscopy-guided distal and proximal locking

DETAILED CONTENT

• Entry Portal Planning: Definition of the access point through the patellar tendon, aligned with the previously marked femoral axis, allowing for precise guidewire trajectory into the medullary canal.
• Operative Positioning and Table Setup: Patient placed in a supine position with controlled knee flexion and use of a split table to facilitate C-arm access.
• Guidewire Insertion and Intramedullary Alignment: Guidewire insertion technique with confirmation in anteroposterior and lateral views to ensure parallelism with the medullary canal.
• Fracture Reduction and Rotational Control: Strategies for rotational correction using references from the lateral femoral cortex, allowing for a reconstruction closer to anatomical alignment.
• Progressive Reaming of the Medullary Canal: Technical sequence of reaming aimed at accommodating larger diameter implants and improving the stability of intramedullary fixation.
• Secure Nail Positioning: Criteria for proper nail positioning above the lesser trochanter, avoiding stress concentration zones and the risk of subtrochanteric fracture.
• Distal Locking Technique: Precise alignment of the skin incision with the nail holes and fluoroscopy-guided drilling for secure insertion of distal screws.
• Proximal Locking and Rotational Stability: Insertion of proximal screws with radiographic control for definitive stabilization of the osteosynthesis.
• Final Implant Assessment: Verification of alignment, fracture reduction, and absence of implant prominence.
• Layered Closure: Anatomical reconstruction of surgical planes with paratenon, subcutaneous, and skin sutures.

MATERIAL INCLUDED

Detailed PDF: Didactic document that objectively presents the principles of retrograde intramedullary nailing of the femur, including entry portal planning, patient positioning, guidewire insertion technique, progressive medullary canal reaming, criteria for nail positioning above the lesser trochanter, and the technical sequence of distal and proximal locking under fluoroscopy.

Improve your execution in intramedullary fixation of the femur and incorporate a systematized technical sequence for reduction and stabilization of diaphyseal fractures. Enroll and strengthen your practice in trauma surgery.