“Sleeve Awl’’ For Femoral Intramedullary Guide Rod Insertion

Abstract

Background : Making a hole at the piriformis fossa of the femur is one of the important steps in closed intramedullary femoral nailing . This hole is provided for passage of the devices through it. We design a device that is used as a hole making and the sleeve for changing the instruments. This device facikitates and reduces the time for this procedure.

Objective : To present the use of a new device for facilitating and reducing the operative time in closed intramedullary femoral nailing procedure.

Study design : Experimental study

Setting : Orthopedics department, Faculty of Medicine, Khon Kaen University

Device : “Sleeve awl” was innovated from a 14 –mm. diameter Kuntscher nail which was cut at one end and shaping as a bevel. “Sleeve awl” was used instead of the conventional awl in the closed intramedullary femoral nailing procedure. After pointing the bevel of the “Sleeve awl” into the piriformis then it was driven into the medullary canal of the proximal femur. Leaving the  sleeve awl at this position as a channel for passage of the T-hand reamer and reamer guide rod.

Result : The closed intramedullary femoral nailing was performed in 20 cases. All of them were divided equally into 2 groups. The conventional awl was used in the first group and the sleeve awl was used in the second group. The first group consisted of 8 men and 2 woman, the means age were 30.2 years (10-73years). The femur was on the left in 3 cases and on the right 7 cases. The second group consisted of 7 men and 3 woman, the means age were 30.5 years (15-52 years). The femur was on the left in 4 cases and on the right 6 cases.

The average times from insertion of the awl into the medullary canal of the proximal femur to the insertion of the guide rod in the first group was 7.13 ± 2.22 minutes (5.20 – 13.20 minutes), and in the second group was 2.25 ± 0.58 minutes (1.30-5.00 minutes) (t-test, p = 0.00001) mean difference = 4.76;95% confidence interval = 3.03,6.48

Conclusion : The “Sleeve awl” is a useful device for facilitation in closed intramedullary femoral nailing procedure. The use of this device will reduce the time for seeking the hole at the piriformis fossa at each time for changing the instrument through this site as in the conventional method.

Key words : awl, fracture of femur