Procedure

position

1. Position and mount the affect the arm on limb positioner

2. Skin preparation and draping

Incision

3. Skin incision

4. Identify entry site under X-ray and open with awl, guide wire or Kwire

5. Reduction using guide rod

6. Reaming: Apply tissue protector. Perform intra-medullary reaming with flexible reamer gradually. Change of guide rod if needed with plastic tube.

Nail insertion

7. Mount the selected nail to the jig handle with connecting screw and attach the aiming arm accordingly.

8. Insert Nail by gentle rotation and should be advanced with manual pressure.

Porximal and distal locking

9. Guided locking via target device (antegrade: proximal; retrograde: distal)

10. Freehand locking using radiolucent drill bit (antegrade: distal; retrograde: proximal)

End cap insertion

11. Insertion of end cap to prevent in growth of soft tissue

Wound closing

Vicryl 1, Vicryl 2/O and Ethilon 3/O

Cosmopore (S)

Plain gauze 

Velband

Crepe