Henrik Eckardt Operative Technique T2

Overview

o  When shall we nail? o  Patient position o  Nail entry-point o  Ream or not ream o  Rotational control o  Knee prosthesis o  Poller-screw o  Outcome

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When shall we nail?

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When shall we nail?

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When shall we nail?

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When shall we nail?

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Open fractures?

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Patient position

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Patient position

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Patient position

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Patient position, semi-extended, para-patellar

11 Tornetta, JOT 1995

Patient position, semi-extended, supra-patellar

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Semi-extended

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Semi-extended vs. bent knee

+ Easy to position and X-ray Better reduction by proximal Fx Better reduction by distal Fx - Increased pressure on cartilage +/- Anterior knee pain 14

Entry point lateral or medial

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Reamed nailing

Reamed: Lower risk of non-union in closed fracture (small) Reamed: Lower risk of hardware failure (small) No difference: Infection Malunion Compartment syndrome

16 JBJS 2008, SPRINT Trial Cochrane 2012

Ream or not ream

17 JBJS 2008, SPRINT Trial

Rotational control

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Knee prosthesis

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Poller screw

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Poller screw

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Outcome

Non-union closed fracture, 6-11% Non-union open fracture, 9-15% Healing time 12-24 weeks depending on soft tissue damage Infection risk open fracture 9-20%

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What to do?

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