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Crurisfracture
(fracture of the lower leg)
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This patient has suffered a fracture of his lower leg due to a soccer injury. An operation is indicated because the fracture is not stable. The fracture is well suited for a so called locking nail osteosynthesis. Osteosynthesis is the operative fixation of a fracture. This can be done with plates and screws, with external fixation or with a nail as in this case. Because a simple nail can lead to rotation, screws are inserted through the nail to prevent this.
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The patient is positioned with the leg hanging down. The other leg is held up to facilitate the use of a x-ray device (3). An incision is made at the knee and the deeper layers are cut to reach the bone that is entered with an awl. Then a guide wire is inserted in the bone (4-8).
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With a special drill room is created for the nail. A special device tells the length of the nail (9-12).
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The nail is prepared with a device to facilitate the introduction and placing of the locking screws. Introducing the nail may need some hammering! The x-ray device is used to control the procedure and the positioning of the nail (13-16)
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As the nail is in place the locking screws are inserted through the device at the knee. In the lower leg this has to be done by hand because torsion of the nail always occurs with introduction. The x-ray device is indispensable with this procedure (17-24).
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A compressive bandage is applied and check-up x- rays are made the day after (25-27). In this case full weight bearing is allowed, guided by the pain of the patient. After healing the nail may be removed. This can be done after about one and a half year.