CRPP FEMORAL NECK (NON-DISPLACED)

Flat Jackson table supine with bump under hip

Bring to the edge of the table
Drape arm across chest with Kerlix
Prep in entire leg to belly button so you can get high on hip (1015 drape)
Down sheets, sticky blues, splits
C-armor always bring more proximal for laterals
**check under Jackson table padding for lead from previous surgery
Use partially threaded pin, bring C-arm in to mark out the superior and inferior borders of the
femoral neck (roll the pin down the leg so you can extend to the lateral edge of the femur)
Mark the level of the Greater Trochanter your starting position with pin is just
proximal/superior to the LT
Incision should be on posterior of the femur (need to aim toward anteverted neck) make
incision approximately 5cm in length
Incise through IT band extend proximally more than you think (angle of pin to get into neck)
Use partial threaded guide pin on power
AP fluoro to get starting point and angle on inferior neck
Use pin tip to feel Ant/Post edge of the femur (want to be on posterior 1/3)
Drop hand some to aim up at femoral head
Once you like position based on A/P location of the tip and the level based on AP fluoro, drive in
1-2cm
Check lateral position XR
If you need to adjust position, use oscillator to come in reverse DO NOT EXIT THE STARTING
HOLE If you do, feel for hole use XR to view hole if possibleThis is easiest to use your left
hand to stay on bone, dont allow pin to exit requires adequate IT band release
Once happy with pin placement, drive 5-7mm from femoral head always check again on
AP/Lat
Use multi-pin guide (gatling gun) place pin through posterior/inferior triangle position
Place second pin in superior/anterior triangle site, drive 1cm into bone, check AP/Lat XR
DO NOT TORQUE pin guidecan push against bone through IT, but once there, do not want to
push further you want these pins to be parallel and can change this by pushing guide
May need to incise IT band further to get guide completely down to bone
If happy with 2nd pin placement, drive in to femoral head and then do the same to the 3rd pin in
the superior/posterior part of triangle.
MAKE SURE TO CHECK AP/LATERAL WITH ALL PIN PLACEMENTS, FLUORO PIN LOCATION TO
ENSURE NOT OUT OF FEM HEAD
Remove pin guide
Use cannulated drillmake sure you bring back and forth to ensure you are co-linear with guide
pin
Drill inferior pin firstif co-linear, the pin will stay in. BOUNCE to get deep and stay short of end
of pin.

Measure using the cannulated measuring guide, make sure it is down to bone
Once drilled and measured, place Inferior screw 6.5mm partially threaded with washer; Put on
power, and then by hand. Check AP/Lateral to ensure length.
Place 2nd, 3rd screws 6.5 fully threaded, no washer (to avoid prominence)
Once screws are in place, remove pins and check AP/Lateral and Fluoro entire joint to check
screw lengths.
Irrigate
Close IT band with 0-Vicryl
Close subdermal layer with 2-0 Vicryl
Close skin with nylons/staples/3-0 Monocril