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SIGN NAIL / FIN NAIL

FRACTURE of TIBIA

Procedure: 

  • Place the patient in a supine position with knee flexion 90 degree under spinal anesthesia
  • Skin antiseptic by betadine scrubbing, and draping except surgical site 
  • Mark out inferior pole of patella from the border of patellar tendon to tibia tubercle
  • Incision through the skin and subcutaneous above 5cm to patella tendon in intramedullary nailing approach
  • Open cortex of the port entry by a solid awl
  • Reduce fracture by pulling traction over triangle
  • Hand reamer from 7mm to 11mm to canal of tibia bone
  • Insert SIGN Nail 9mm x 300mm with a distal locking screws 30mm and a proximal locking screw 30mm
  • Washing with normal saline
  • Close peripatellar arthrotomy with 1-0 vicryl 
  • Subcutaneous with 2-0 vicryl and skin closure with 2-0 nylon
  • Skin closer with nylon then dressing with sterile compressive

Post operation treatment: 

  1. PIV NSS 0.9% 1000ml/24H or PIV D10 / D5
  2. Cefoperazone + Sulbactam (1g): 1fl x 2 (PIV) or Ceftriaxone (1g): 1fl x 2 (IVL) or Gentamycine (80mg): 1A x 2 (IM) or Metronidazole (500mg): 1fl x 2 (PIV)
  3. Paracetamol (1g): 1fl x 3 (PIV)
  4. Tramadol (100mg): 1A x 2 (IM)
  5. Cimetidine (200mg): 1A x 2 (IVL)


FRACTURE FEMORAL


NAIL Retrograde

  • Position the patient supine with knee flex 30 degree under epidural anesthesia
  • Skin antiseptic by betadine scrubbing and draping except surgical site
  • Incision through the skin above 8cm of femoral in lateral approach
  • Dissect through subcutaneous and fascia to the bone fragment 
  • Bone reduction and stabilization of bone fragments with (two cerclage wires)
  • Incision and dissect through subcutaneous and arthotomy 5cm from inferior pole of patella distal through patellar tendon in medial parapatellar approach
  • Guidepin start point in the center of intercondylar notch with small drill bite 
  • Stat with 7mm reamer to 12mm reamer in canal of femoral bone
  • Insert FIN / SIGN Nail 10 x 36cm with a proximal locking screw 60mm and a distal locking screw 40mm
  • Lavage the surgical site with normal saline /+- betadine
  • Close peripatellar arthrotomy with 1-0 vicryl 
  • Close fascia lata with 1-0 vicryl
  • Subcutaneous suture with 2-0 vicryl and skin closure with 2-0 nylon
  • Dressing with sterile compressive 

Post Opt Treatment:

  1. PIV NSS 0.9% 1000ml/24H
  2. Ceftriaxone (1g): 1fl x2 (PIV)
  3. Paracetamol (1g): 1fl x 3 (PIV) 
  4. Tramadol (100mg): 1A x 2 (IM) 
  5. Cimetidine (200mg): 1A x2 (IVL) 


NAIL Antegrade:

  • Position the patient lateral under epidural / spinal anesthesia
  • Skin antiseptic by betadine scrubbing and draping except surgical site
  • Incision through the skin above 8cm of femoral in lateral approach
  • Dissect through subcutaneous and fascia to the bone fragment 
  • Bone reduction and stabilization of bone fragments with (two cerclage wires)
  • Incision 5cm through subcutaneous and dissection through the fascia above greater trochanter in lateral approach to the hip
  • Piriformis starting point is on the piriformis fossa 
  • Insert guidepin to the entry port in to the canal of femoral bone / Open cortex of the port entry by a solid awl
  • Start with 7mm reamer to 11mm reamer through entry hole 
  • Insert SIGN Nail 9 x 34 follow anterior bow of femur with distal locking screw and proximal locking screw
  • Close fascia lata with 1-0 vicryl 
  • Subcutaneous with 2-0 vicryl and skin closure with 2-0 nylon
  • Dressing with sterile compressive

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