This document discusses surgical techniques for subtrochanteric fracture surgery using a simple table. It provides step-by-step guidance on positioning the C-arm for imaging, inserting guide wires and pins, reaming the femoral neck, inserting intramedullary nails, and completing distal and proximal locking. Images are included showing appropriate positioning and progression of the surgical steps. The technique aims to allow surgeons to manipulate hardware without leaving the operative field for additional imaging.
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Surgery of SUB TROCHANTERIC FRACTURES on simple table
1. Surgery of
SUB TROCHANTERIC
FRACTURES
on simple table
Dr. B. Shivashankar.
Iyer Orthopaedic Centre, Solapur
ISO 9001:2008
Certified Hospita
President 2008-09
National Association of Interlocking Surgeons
6. On Ordinary Radio Lucent Table
C arm Position for Cross Table hip
lateral View
X Ray tube under the table, Image intensifier
Near the operative hip to avoid too much zooming
7. C arm Pictures of Hip in Cross Table
lateral view
Both hips seen, the one nearer the X ray tube (underneath table)will be magnified, the operative
side hip will be seen comparatively smaller as the Camera is nearer to same, confirmed by
Passing Steinmann pin passed into the pirifiormis fossa of operative hip.
For Doing PFN Pass an anteversion Guide wire parallel to anterior cortex as marked with the
arrow in next slide.
8. C arm Picture of Hip in Cross Table
lateral view
Anteversion Guide
wire
For Doing PFN Pass an anteversion Guide wire Parallel to anterior cortex
as marked with the arrow in the slide and keep the jig parallel to the
same while passing guide wires for neck fixation as shown on right.
9. Advantage – When surgeon inserts Guide
Pin, he need not have to get out of the way
just for C Arm pictures, He can manipulate
the Guide pin to best position!(seen here)
IITV for Hip Lateral View
IITV for Hip AP View
C arm monitor is towards foot end of the table . Surgeon, Assistant and the
X ray technician, all of them can see the picture
10. Cross Table Lateral View
See the normal B and Operative
side A (enlarged as the hip is nearer
To X ray tube underneath)
A
B
25. Nail Blocking the view of Guide Wires in
Lateral View, But both anterior and
posterior cortex of the neck seen
26. By rotating the jig along with anteversion Guide wire
Guide wires in the neck can be seen.
Please do not rotate only the jig, that will cause
Bending of the guide wires, Rotate along with anteversion
Guide wire to control the rotation of proximal fragment
30. Flex the knee to enable heel to touch ischeal tuberosity to
Align fragments rotationally correct and then do
distal locking by free hand. Proximal jig not removed
To hold and keep the nail hole perpendicular to ground
31. Drill at the distal end of oblong hole to avail
Dynamisation possible and pass distal IL Bolt
51. Video Clip on You Tube
• Short Video Clip of 3.2 minutes on You Tube is
available as
http://www.youtube.com/watch?v=o2v-ewedvWQ
Copy paste above link on your browser
53. Disclaimer
• For educational purpose only for use
by Medical students and Orthopaedic
Surgeons.
• View expressed are personal
• If copied for presentation purpose
kindly give credit to the author.
• No financial interest involved
• Any Query Contact :
Dr. B. Shivashankar on
<drbshivashankar@gmail.com>