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Guide Wire Femur Use in Intramedullary nailing

Insertion of a guide wire

Manual reamer

Using one of the techniques to prepare the entry site typically enables the insertion of the guide wire Femur into the diaphyseal medullary canal. If there is still cancellous bone in the way, use a hand reamer to finish the entry. When the medullary canal is blocked by callus, these instruments (with diameters of 6, 7, and 8 mm) are also useful for treating old fractures and non-unions.

rounded-tip guide wire

Pass a ball tip guide wire into the distal metaphysis through the medullary canal after the proximal metaphysis has been broken. Reduction of the fracture is necessary. Special efforts might be needed if fracture reduction is challenging or the fracture has become comminuted.

the guide wire being bent

Two benefits result from slightly bending the guide wire 10-15 mm above its tip:

1. Because the wire’s tip is redirected by rotation, it is simpler to pass through the fracture site and into the distal fragment.
2. It also makes it easier for the tip to be placed correctly in the distal metaphysis.

In order to prevent jamming inside a cannulated reamer, a guide wire femur with the ball situated slightly closer to the end allows the bend to be positioned beyond the ball.

control using fluorescence

Make sure the guide wire Femur is above the ankle joint’s middle using fluoroscopy.

determining the length of a nail

Nail size

Preoperative nail length estimation is done, but intraoperative measurement is more accurate. Utilize the radiographic ruler that was included with the nail’s tools. Measure the distance from the intended nail entry site to just above the ankle joint after the fracture has healed.

Choose a nail that penetrates the distal femur all the way to the entry point without peeking above the surface of the bone. When treating distal fractures, nail length might be crucial. To compensate for an excessively short nail, some nails have proximal extensions of various lengths that can be added after insertion.

A straightforward, clinical intraoperative length measurement is suggested if a radiographic ruler and/or image intensifier are not available. Place a second guide wire of equal length at the entry portal while the intramedullary guide wire femur is in the correct position. Then, measure the length difference between the two wires.

reaming and measuring the diameter of the nails

Reaming

Over the ball-tipped guide wire, place the flexible-shaft reamer with a cannula.

Starting with an end-cutting reamer, increase the reamer diameter incrementally, typically by 0.5 mm. During this process, use a reamer sleeve, as shown, or suitable retractors to protect the soft tissues at the entry site.

Reamer should not be pushed! Pull back a little every so often as you advance to clear the medullary canal of debris.

The reamer is in contact with the internal cortical surface when there is a chattering sensation. An appropriate diameter nail can usually be passed with an additional millimeter or two of reaming.

selecting the nail diameter

A radiographic gauge is used to measure the diameter of the medullary canal. Check the lateral and AP views.

The nail diameter must be sufficient to ensure the strength and longevity of both the nail and the locking screws. Seek advice from the manufacturer of the nails. A 10 mm nail is typically adequate. Given that the medullary canal is not perfectly straight, reaming should be done to a diameter of 0.5 to 1.5 mm greater than the nail.

Getting ready to insert a nail

Nails with cannulas are inserted over the proper guide wires. For a solid nail, no wire is used. It may not be possible to remove the ball-tipped, or significantly bent, guide wire femur through a particular cannulated nail. If so, a new wire needs to be installed before the nail is put in. For changing guide wires, a plastic medullary exchange tube is available. Pass the medullary tube completely past the fracture site and over the reaming guide wire. While removing the reaming guide wire, keep it steady.

Check that the nailing wire is properly positioned in the distal femur using AP and lateral x-rays after inserting it through the tube. The medullary exchange tube should then be removed.

Putting the cannulated nail in

Inserting nails

The cannulated nail should be able to be inserted over the guide wire femur by hand or with light hammering with enough reduction and over-reaming. Make sure to keep the fracture reduced as the nail crosses it. If insertion is challenging, ream to a larger diameter and/or correct the reduction.

To lessen the chance of knee pain, make sure the proximal end of the nail is buried beneath the surface of the bone at the entry site. For distal fractures in particular, careful nail length selection may be required to guarantee distal fixation and the correct length proximally.

The distal femur’s middle should be where the nail tip is positioned, roughly at the level of the physeal scar (a denser bone). For fractures below the medullary isthmus, it is crucial to place the nail distally. The surgeon must maintain proper fracture alignment because, at this level, nail passage does not weaken the fracture.

Pitfalls

Each time you tap the hammer on the nail, the nail should move closer to the medullary canal. If resistance is felt, it might be because the entry point was chosen incorrectly or because the distal fragment’s cortex was struck by the nail tip.

Forced hammering can result in nail incarceration, fracture comminution, or nail twisting.

Guide Wire Femur Risk Factor 

When assessing the prognosis in each case, contraindications—which may be partial or complete—must be taken into account. Under the following circumstances, alternative management strategies may need to be taken into account:

• infections that are systemic or local, acute or chronic.
• either localized, systemic, or chronic inflammation.
• serve as a dangerous vascular, nervous, or muscular disease.
• Bone defects that would prevent the implant from being properly anchored.
• All associated illnesses that might jeopardize the implant’s success and functionality.

Warnings and Precautionary for Guide Wire Femur

Before using Guide Wire Femur, the surgeon and supporting personnel should read the safety instructions in this document as well as any product-specific information in the product description, surgical techniques, and/or brochures.

Guide Wire Femur is designed, built, and produced with the utmost care using materials of the highest quality for medical use. If used properly, these high-quality guide wires guarantee the best working outcomes. The usage guidelines and safety advice that are provided below must be followed.

Inappropriate use of guide wires can result in injury to the operator, patients, or other people in addition to damaging the tissue, hastening wear on the instruments, and instrument destruction.

It is essential that the operating surgeon actively participate in the medical care of their patients. All facets of the surgical procedure and the tools used, including their limitations, should be fully understood by the surgeon. It is the surgeon’s and the surgical team’s responsibility to take care in the selection and use of surgical instruments. Prior to using implants, sufficient surgical training must be obtained.

The following variables could harm the operation’s success:

• implanted material allergies.
• specific bone tumors.
• both osteoporosis and osteomalacia.
• disordered metabolism and systemic disease.
• abuse of drugs and alcohol.
• The implant is exposed to blows and/or excessive loading during physical activities that involve strong shocks.
• Patients who are mentally incapable of understanding and following instructions from the doctor.
• unhealthy in general.
• Effects that could be harmful
• The most frequent side effects of implantation are the ones listed below:
• Guide Wire Femur loosening, which may be caused by cyclic loading of the fixation site and/or tissue reaction to the implant.
• infection both early and late.
• additional bone fracture brought on by unusual stress or weakening of the bone matrix.
• pressure or hematoma-induced temporary or permanent neural damage.
• Hemorrhages and slow wound healing.
• Heart arrest, pulmonary embolism, and venal thrombosis are examples of vascular disease.
• Ossification that is heterotopic.
• Pain and discomfort brought on by the Guide Wire Femur’s presence.
• Failure due to mechanical forces, such as bending, loosening, or breakage of the implant.
• Implant migration that causes harm.

Preoperative Planning for Guide Wire Femur

Following a thorough clinical evaluation of the patient, the operation is planned. X-rays are also necessary to provide a clear picture of the bony anatomy and any associated deformities. A full size of the Guide Wire Femur must be on hand at the time of the operation, along with the appropriate implantation tools.

The potential risks and complications related to the use of implants should be discussed with the patient by the clinician. If the patient has allergies to any of the implant materials, it is crucial to know this before surgery. Additionally, the patient needs to be made aware that the device’s performance cannot be guaranteed because problems may reduce its lifespan.

Guide Wire Femur Precautions

During the reprocessing process, verify the instruments’ functionality and look for wear. Before using, replace any damaged or worn out instruments.

It is advised to use the tools designated for this Guide Wire Femur.

Use caution when handling equipment, and put sharps containers in which to dispose of used bone cutting tools.

Always use irrigation and suction to get rid of any debris that might get created during implantation or removal.

Guide Wire Femur Warnings

When put under excessive force, the Guide Wire Femur may break while being used. We advise that, whenever possible and practical for the particular patient, the broken part should be removed. The surgeon will ultimately decide whether to remove the broken part based on the risk involved. Be aware that implants lack native bone’s tensile strength. Implants that are subjected to heavy loads may fail.

Sharp edges or moving joints on tools, screws, and cut plates could rip or pinch the user’s glove or skin.

Make sure to get rid of any fragments that weren’t surgically fixed.

The final decision to remove an implant rests with the surgeon, but we advise that fixation devices be taken out as soon as it is safe and practical for the particular patient and after their purpose as a healing aid has been fulfilled. To prevent refracture, adequate post-operative management should be performed after removing the guide wire from the femur.

Guide Wire Femur General Adverse Events

There are risks, side effects, and adverse events associated with all major surgical procedures. While there are many possible reactions, the following are some of the most frequent ones: issues related to anesthesia and patient positioning (such as nausea, vomiting, dental injuries, neurological impairments, etc.), thrombosis, embolism, infection, damage to nerve and/or tooth roots or other critical structures, such as blood vessels, excessive bleeding, damage to soft tissues, including swelling, abnormal scar formation, functional impairment of the musculoskeletal system, and pain.