The dilatation approach with the TNS for the minimally invasive implantation of intramedullary nails at the proximal femur (vol 103, pg 413, 2000)

A new technique of a minimally invasive approach to the proximal femur was developed for the management of per- and subtrochanteric fractures using intramedullary nail blade systems. For creating the entry portal at the proximal femur a transkutaneously applied Kirschner-wire is used. Subsequently, a new developed trocar system (TNS) for the protection of the soft tissue during reaming procedures is placed via a small cutaneous incision. The reaming of the femoral shaft can be performed through this trocar system. A new targeting jig especially adapted to the gliding nail was used in this first series. From December 1998 to June 1999 12 patients were treated with this new technique in the Department of Trauma Surgery of the Philipps-University in Marburg. The mean age of the 8 female and 4 male patients was 78 (+/-12) years. The majority of the total group were old patients with a mean ASA score of 3-4. Relevant intraoperative complications using the new dilatation approach were not observed. All patients were mobilised after few days. Postoperative complications or infections were not found. In the clinical practice of the management of per- and subtrochanteric femoral fractures the new dilatation approach has proved to be more comfortable and minimally invasive than the standard technique existing to date.