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© PEGA MEDICAL 2000 Last update: 08/03/2000
CHOICE OF THE
TECHNIQUE
The standard technique usually employed is the open osteotomy technique.
For patients with large bones and thin cortices, the use of the per cutaneaus
technique is recommended.
CHOICE OF
NAIL SIZE
Estimate the length (l)
of the rectified bone after osteotomy(ies). l is the distance between
the greater trochanter and the distal growthplate. The length of the
female hollow component is cut pre-operatively to a length of l-7 mm.
The length of the male solid nail is cut intraoperatively after both
components are implanted, leaving 10 to 15 mm protruding from the proximal
end to accommodate for future growth. The choice of L (long) or S (short),
which defines the length of the distal thread, should be based on the
length of the distal ephiphysis as measured from A-P x-ray film.
OPEN
OSTEOTOMY TECHNIQUE
STEP 1
Through a classic postero-lateral approach, the femur is exposed sub-periostally.
Subsequently the first osteotomy is executed under c-arm guidance.
STEP
2
Reaming of the proximal fragment is done with a cannulated reamer or drill up
to the greater trochanter over a small diameter K-wire for guidance. The diameter
of the reamer should be 0.25 to 0.35mm larger than the diameter of the Fassier-Duval
Nail implant size chosen. The distal fragment is prepared in the same fashion.
If the K-wire guide does not reach the distal epiphysis, a second osteotomy
should be performed after reaming the intermediate fragment.
STEP
3
A male-size K-wire is inserted on the retrograde direction from the osteotomy
through the proximal fragment. (in case for a need of a second osteotomy, the
male nail is inserted from the distal osteotomy). A second incision will be
done at the buttock to allow the extremity of the K-wire to exit proximally.
The male driver (MDr132, MDr140, MDr148, MDr156 or MDr164) is introduced over
the male-size K-wire.
STEP
4
The K-wire is removed and the male solid nail is placed in the male driver,
making sure that the wings of the male solid nail are fitted into the male driver
slot.
STEP
5
The male solid nail is pushed distally after reduction of the osteotomy(ies)
and screwed into the distal epiphysis. Verify under fluoroscope that the distal
thread is positioned beyond the growth plate (otherwise normal growth may be
affected.) Optimal position of the male solid nail on the distal femoral epiphysis
is achieved by centering the distal tip on both the Anterio-Posterior and the
lateral views.
STEP
6
Removal of the male driver is done with the assistance of a small diameter K-wire
to reduce stressing of the nail fixation while the driver is pulled back.
