Part I:
Fluoroscopic Examinations 1. FEMORAL NAILING
(AP POSITION)
PATIENT POSITION: Patient will be in lateral position with affected femur up and slightly forward.
C-ARM POSITION: C-arm will enter facing patient. Rotate c-arm underneath the table to the ap projections. Ensure that c-arm is perpendicular to femur.
Notes: When moving from ap to lateral position, make sure not to bump instrumentation.
Position c-arm viewing cart at feet of patient with the doctor standing posterior to the patient.
Create distance and magnify image when creating round holes for distal locking screws.
During reaming, obtain true lateral of knee by tilting and rotating c-arm.
Position the c-arm to view reamers crossing fracture site.
Figure 1.1 C-arm in ap projection of hip.
Figure 1.2 C-arm image of ap hip with nail inserted.
2. FEMORAL NAILING
(LATERAL POSITION)
PATIENT POSITION: Patient will be in lateral position with affected femur up and slightly forward.
C-ARM POSITION: C-arm will enter facing patient. Rotate c-arm 10 to 15 degrees over top of patient. Tilt c-arm 5 to 10 degrees toward head of femur.
This view, called the Winquist View, is used to throw the unaffected femur out of view, to elongate the femoral neck for true lateral viewing of starting position and to check anterior and posterior position.
Notes: When moving from ap to lateral position, make sure not to bump instrumentation.
Position c-arm viewing cart at feet of patient.
Doctor will stand posterior to patient.
Figure 2.1 C-arm in lateral projection with Winquist tilt view.
Figure 2.2 C-arm image of lateral hip with starting auld in place.
Figure 2.3 The c-arm is in the Winquist view, which is best utilized to check anterior and posterior positions in relationship to the femoral shaft. The c-arm is rotated over the top and tilted to elongate the femur.
Figure 2.4 The c-arm in a true lateral view in relationship to femur position. The c-arm is tilted to align with the femur. This will give a better indication of fracture alignment and reamer size.
Figure 2.5 During distal targeting for femoral nail, raise the c-arm away from the knee to enlarge the hole and create working space. Use the magnify button on the c-arm if available.
Figure 2.6 Incorrect hole alignment. Note how hole is oblong.
Figure 2.7 Correct hole alignment. Note that hole is now rounded.
3. SUPRACONDYLAR FEMORAL NAIL
(AP VIEW)
PATIENT POSITION: Patient will be supine with the affected knee slightly bent on radiolucent table.
C-ARM POSITION: C-arm will enter perpendicular to patient and in the ap position.
Notes: Ensure underneath clearance allows for movement from the knee to the hip.
C-arm may have to be rotated over or backward to create a true ap view.
Tilt c-arm to open joint space of knee for starting point.
Figure 3.1 C-arm in ap projection of distal femur.
Figure 3.2 X-ray image of distal femur.
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