Retrograde Approach To Femur - Sign IM Nail and Interlocking Screw System Technique Manual

SIGN technique that is used in all bones is recorded beginning on page 11.
Indications distal
Fractures in the distal femur should be treated with retrograde approach. This is surgeon preference. If
manipulation of the knee is done after the nail insertion and interlocking and range of motion
exercises follow postoperatively, full range of motion usually is achieved and maintained.
Position of the patient
Supine position with a sterile bump or triangle under the knee. 60º of knee flexion is desirable. Knee
extension and flexion allows better visualization of the femoral shaft.
Reduction of the closed fracture
Closed reduction can be done without C-arm in fresh fractures. Open reduction is accomplished by
the mini incision technique dissecting through the muscle fibers without cutting them.
Skin incision
Some surgeons make a medial parapatellar incision
for larger exposure. The median parapatellar
attachments can be released and the patella subluxed
slightly. This allows visualization of the femoral
notch. After more experience, the surgeon makes the
incision through the patellar tendon. This is done by
flexing the knee so the patellar tendon can be
palpated, incising the patellar tendon and removing a
window in the fat pad to see the medial aspect of the
femoral notch. See figure 32 in the tibia section on
page 24.

Retrograde Approach to FEMUR

Bone entrance
Use curved awl to make entrance hole in the
medial aspect of the femoral notch above the
posterior cruciate ligament at junction of
Fig. 2
articular surface, figure 1.
If the entrance is placed too far posteriorly, the
posterior cruciate blood supply will be
compromised. The patella does not articulate
with the articular surface in the area of the
entrance hole, figure 2. Stabilize the distal
femoral fragment as the bony entrance and
reaming take place. Look at the fracture site to
see the direction of the awl and subsequent
reamers.
26
Fig. 1
Bone entrance