Table of Contents
1. Head-Neck Screw Design
The head-neck screw adopts a dual-screw configuration, consisting of a traction screw and a compression screw. These two screws interlock to effectively resist femoral head rotation.
During insertion, the threaded engagement between the compression screw and the traction screw drives axial movement of the traction screw, converting rotational resistance into linear compression across the fracture site. This significantly enhances the screw’s resistance to cut-out. The interlocking mechanism also prevents the “Z-effect”.
- Dual-screw structure
Interlocked traction and compression screws
- Anti-rotation mechanism
Thread engagement transforms rotational stress into linear compression
- Prevents Z-effect
Enhances cut-out resistance
2. Main Nail Design
The proximal design of the main nail mimics a joint prosthesis, allowing better anatomical fit with the femoral medullary cavity and matching the biomechanical characteristics of the proximal femur.
- Proximal prosthesis-like structure
Better match with medullary cavity biomechanics
1.Patient Positioning
The patient may be placed in a lateral or supine position. In the supine position, an X-ray-permeable surgical table or orthopedic traction table should be used. The unaffected limb is abducted and fixed to a support, while the affected limb is adducted by 10°–15° to align with the medullary canal.
Lateral or supine positioning
Uninjured limb abducted and fixed; injured limb adducted 10°–15° for canal alignment
2.Preoperative Reduction
Closed reduction is performed using a traction table. Under fluoroscopic guidance, the limb is adjusted to a slightly internally rotated and adducted position. Most fractures can be satisfactorily reduced in this manner.
Preoperative reduction is crucial. Avoid open reduction unless necessary, as this saves time and simplifies the procedure.
If reduction is difficult, a small incision can be made, and auxiliary instruments such as bone tamps, retractors, or reduction clamps can be used. Minor separation of the fracture ends does not require repeated adjustments—fracture ends often realign during insertion of the compression screw.
The design of the intramedullary nail does not require medial cortical continuity. In general, reduction of the lesser trochanter fragment is not necessary. Minimally invasive closed reduction preserves blood supply, facilitating healing.
However, coxa vara deformity must be corrected before nail insertion. Postoperative ambulation and weight-bearing should be delayed appropriately.
Traction table adjustment (slight internal rotation and adduction)
Auxiliary tools for difficult reductions (bone tamp, retractor, reduction clamp)
Correct coxa vara; adjust postoperative mobilization and weight-bearing timing
3.Incision and Entry Point
The patient may be placed in a lateral or supine position. In the supine position, an X-ray-permeable surgical table or orthopedic traction table should be used. The unaffected limb is abducted and fixed to a support, while the affected limb is adducted by 10°–15° to align with the medullary canal.
Incision site
3-5 cm longitudinal incision proximal to the greater trochanteric apex approximately flat to the anterior superior iliac spine A 3-5 cm longitudinal incision is made proximal to the greater trochanteric apex approximately flat to the anterior superior iliac spine. A Kirschner pin can be placed on the lateral side of the proximal femur and adjusted under C-arm fluoroscopy to coincide with the long axis of the femur to position the incision more accurately.
Entry point positioning
The apex of the greater trochanter is slightly medial, 4° lateral to the long axis of the medullary cavity in the orthopantomogram.The entry point is slightly medial to the apex of the greater trochanter and corresponds to a 4° lateral deviation from the long axis of the medulla on the orthopantomograph. On the lateral view, the entry point is located on the long axis of the medulla.
Marrow expansion requirements
The proximal end is sufficiently dilated until the restrictor contacts the entry tool, and the distal end is determined by the condition of the medullary cavity.
Because the proximal end of the main nail of the femoral trochanter type II is relatively large, the nail can be entered only after adequate intraoperative expansion of the marrow, proximal expansion should be made so that the restriction device of the expansion drill can be stopped when it touches the inlet channel tool, and whether or not to expand the marrow of the distal femoral stem needs to be decided according to the size of the medullary cavity, such as the proximal femoral stem medullary cavity was found to be significantly narrowed by the preoperative X-ray, the preoperative preparation of the femoral stem expansion drill, such as insufficient expansion of the marrow, which would result in difficulties in the entry of the nail.
4.Important Precautions
Avoid forceful hammering
To prevent splitting of osteoporotic bone or fracture displacementSlight lateral wiggle of the nail during insertion is acceptable, but avoid excessive impact on the nail tail, which may cause intraoperative cortical cracking or loss of reduction.
Our Intertan femoral intramedullary nail is specially designed for complex intertrochanteric and subtrochanteric femoral fractures. Featuring anatomical alignment, dual integrated screws, and multiple size options, it provides safe, stable, and rotationally controlled fixation solutions for clinical orthopedic surgery, particularly in osteoporotic patients.
Model: T1100-21
Model: 1200-13
Model: 1000-0131
