IM roding Gamma nail, long Gamma

PREOPERATIVE DIAGNOSIS:  Peritrochanteric proximal femoral shaft subtrochanteric fracture, right femur.

POSTOPERATIVE DIAGNOSIS:  Peritrochanteric proximal femoral shaft subtrochanteric fracture, right femur.

OPERATION PERFORMED:  IM roding Gamma nail, long Gamma 125-degree, right femur with 11 x 380 nail, 90-mm lag screw, and 40 x 5 distal locking screw.

ESTIMATED BLOOD LOSS:  75 mL.

COMPLICATIONS:  None.

DRAINS:  None.

SPECIMENS:  None.

ANESTHESIA:  Spinal.

PROCEDURE IN DETAIL:  Following induction of anesthesia, the patient was placed on the fracture table in a supine position.  All bony prominences were carefully padded and protected.  The left leg was placed on the stirrup leg holder.  The right leg was placed in traction and reduction was achieved under fluoroscopic visualization of the right subtrochanteric and peritrochanteric fracture.  The patient wad prepped and draped in sterile fashion.  Prophylactic antibiotics of 1 g Ancef had been given.

A longitudinal incision was made at the tip of the trochanter.  The guide rod was passed through the arm and position visualized at the AP and lateral planes, and noted to be in good alignment.  The rod was measured utilizing the measuring guide, and the rod length was selected to be 380.  The canal was then progressively reamed to 13 mm distally, 15 mm proximally, followed by the insertion of the 125-degree long Gamma 11 x 380 nail.  The nail was appropriately positioned fluoroscopically, and utilizing the proximal guide, the femoral head and neck were drilled with the guide pin, followed by reaming, followed by measuring, and insertion of the 90-mm lag screw.  The lag was appropriately positioned.  The compression screw was tightened proximally and compression was achieved.  Fracture of the hardware visualized in the AP and lateral planes and noted to be in good alignment.  With the traction released, appropriate fracture position was obtained and the proximal jig was removed.  The perfect circle was obtained in the distal locking screw site with the proximal dynamic slot.  The drill hole was made in the proximal portion of the slot, measured, and a 40 x 5 mm screw was then inserted.  The position of the screw was verified in the AP and lateral planes and permanent radiographs were obtained of the rods and fracture proximally and distally.  The wound was irrigated copiously with antibiotic irrigations.  The fascia was repaired with #1 Vicryl interrupted vertical mattress sutures.  The subcutaneous was closed with 2-0 Vicryl interrupted vertical mattress sutures, and the skin was closed with staples with Adaptic, 4 x 4’s, ABD's, and Micropore tape applied.  The patient was sent to the recovery room in a good condition.