These nails are designed to enter through the lateral aspect of the greater trochanter and not through the piriformis fossa or trochanteric tip. The lateral entry approach decreases the chance of damage to the blood supply of the femoral epiphysis (see neurovascular anatomy).
Note on illustrations
Throughout this section generic fracture patterns are illustrated as:
Reduced and provisionally stabilized
2. Instruments and implants
Pediatric nailing set
For advice on specific nail types consult the relevant surgical technique guide.
Determination of nail diameter
Young adolescents may have very thick cortex and narrow medullary canal. It is therefore important to carefully select the nail diameter.
Use pre- or intraoperative x-rays to determine the narrowest point of the medullary canal from the AP and lateral views and therefore the nail diameter.
Alternatively, select the appropriate diameter after sequential reaming of the canal.
Determination of nail length
Estimate the correct nail length from the preoperative x-ray. An x-ray of the contralateral side may be needed.