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KMID : 0378019660090120055
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New Medical Journal
1966 Volume.9 No. 12 p.55 ~ p.58
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A Modification of Nailing Procedure in Femur Neck Fractures
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文相圭/Moon, Sang Kyoo
金永珉/南濬卿/李璟泰/李德鏞/Kim, Yung Min/Nam, Joon Kyung/Lee, Kyung Tae/Lee, Duk Yong
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Abstract
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In the treatment of fractures of the neck of the femur, innumerable methods and their modifications have been devised since Smith-Petersen first introduced a stainless steel three-flanged nail. What one may call a standard technique has evolved, however, which is more or less universally accepted today. It essentially consists of use of the °operating room, use of a fracture table, a five to six-inch incision, and X-ray guidance in introducing guide pins and the Smith-Petersen nail.
The authors have modified the sD-called closed reduction and closed nailing of Temple University in Philadelphia which employes a Chamberlain Multiplane Fluoroscopy in the Fracture Room, Operation is performed in the Fluoroscopy Room of the X-ray Department. This reduces a considerable amount of operating time. The table in the Fluoroscopy Room, is used instead of a fracture table. Fracture is reduced by manipulation and the reduction held by two unscrubbed assistants. The reduction is confirmed by a set of AP and lateral spot X-ray. Meanwhile, the wound is prepared and only the operator and the scrub nurse are scrubbed, sterile gown being worn over lead apron. Three guide pins are introduced by means of percutaneous punctures, the point of entry on the femur being the classical sub-trochanteric region rather than the lower valgus nailing site. At this point, a towel clamp placed on the skin directly over the femoral artery where it passes underneath the inguinal ligament serves as an excellent landmark and alleviate temptation to use fluoroscopy or unnecessary spot X-ays. The second set of spot X-rays are then taken, the proper guide pin is chosen, and through a half inch incision centered around the pin a Smith-Peterson nail is introduced. The third and final set of spot X-rays are taken and the guide pin removed. Impaction of the fracture fragments is not attempted. The skin is closed, requiring 1 or 2 sutures. The authors experienced five cases of fractures of the neck of the femur treated by this method at SNUH during the past three years, from 1963 through 1966. We believe it is a time-saving and least traumatic technique which can be employed at any medical center.
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