Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner

Interlocked intramedullary nailing is now established as the preferred method of managing femoral intertrochanteric fractures. Choosing the ideal entry point and inserting the guidewire accurately are key steps of the procedure. Several factors make the procedure more challenging, such as the supine position, obese patients, and the tip of the trochanter not aligning co-linear with the anatomic axis of the femoral medullary canal in the frontal plane. Our team has developed a new awl with a distal positioner that assists the guidewire insertion and entry portal of femurs. This comparative study analyzed 40 intertrochanteric fracture cases treated with locking intramedullary nailing, which were randomized to receive either the new awl incorporating a distal positioner (n = 20) or the conventional guide apparatus (n = 20). Operation time, blood loss, the success rate of the one-time insertion, radiation times, and bone healing time were recorded. The patients (21 males and 19 females) were treated with Gamma 3 and proximal femur nail antirotation (PFNA) with the help of the new awl with a distal positioner or conventional guide apparatus. There were no transoperative complications in the two groups. The surgical time in the new guide apparatus group was significantly shorter compared to the control group. The new awl group achieved a 100% success rate for one-time needle insertion, surpassing the control group's rate of 66.7%. The fluoroscopy time required for the new awl group was obviously shorter compared to that of the control group. However, no significant differences were observed in terms of intraoperative blood loss or bone healing time between the two groups. The newly designed guide awl with a distal positioner could reduce the difficulty in opening the femur for inserting the interlocked intramedullary nail. This tool is especially suitable for obese patients.