Intramedullary Femoral Nailing - Kedu otu esi ahọrọ ebe ntinysi ahọrọ ebe ntinye kacha mma?

O=wu mmalite

Enwere ike � Intramedullary nailing na ọganihu na usoro ịwa ahụ emeela ka mmụba dị ịrịba ama na ojiji nke intramedullary nailing nke femur.

A na-eji ọgwụgwọ na-agbanwe agbanwe nke femoral stem fractures naanị n'ime ọnụ ọgụgụ dị nta nke ndị ọrịa nwere contraindications dị ukwuu na anesthesia na ịwa ahụ, na isi ọgwụgwọ na-anọgide na-edozi ịwa ahụ. N'ihe gbasara ọgwụgwọ ịwa ahụ nke mgbaji ndị a, e nwere ọtụtụ nhọrọ dịnụ, gụnyere intramedullar� nailing, plate screw fixation, na nrụzi mpụga. E jiri ya tụnyere nhọrọ ịwa ahụ ndị ọzọ, ntu intramedullary bụ usoro nke nwere mgbagwoju anya kachasị dị ala yana ọnụ ọgụgụ ọgwụgwọ mgbaji kachasị elu, ọ na-aghọwanye nke a na-ejikarị eme ihe na ụlọ ọgwụ.

Nghọta dị mma nke anatomi nke femur proximal, ọbara na-enye isi femoral na nhazi ahụ nke akwara hip nwere ike ime ka ọganihu nke intramedullary nailing maka mgbaji femoral. N'ụzọ dị iche, nhọrọ ntinye ntinye na-adabere n'ọtụtụ ihe, gụnyere nhazi ntu intramedullary, ebe mgbaji, mgbaji comminution, na ihe ndị ọrịa (dịka ọmụmaatụ, polytrauma, ime ime, na oke ibu). N'agbanyeghị saịtị ntinye a họọrọ, ịnweta ebe ntinye ziri ezi dị mkpa iji nọgide na-enwe mbelata zuru oke n'oge ntinye ntu intramedullary ma na-ebelata ihe ize ndụ nke nsogbu.

Anatomi Femoral

1.Ọbara na-enye isi femoral

Isi femoral na-enweta vaskụla akwara site na nnukwu akwara atọ. Mpụta rotator femoral artery (nke nwere alaka 3-4), akwara obturator, nke na-enye eriri gburugburu gburugburu, na intermedial rotator femoral artery (Fig 1), nke na-enyekwa arịa na-arịgo elu nke na-anastomoses na akwara rotator femoral akwara ma na-enye mpaghara trochanteric ka ukwuu.

2.Anatomy Of The Hip Muscles

Mgbe ị na-eme ntu intramedullary nke femur, nghọta dị mma nke uru ahụ dị na mpaghara gburugburu rotor dị mkpa iji gbochie mmerụ ahụ na-enweghị isi. Azụ ahụ gluteus medius sitere na ilium wee mechie n'akụkụ akụkụ nke trochanter ka ukwuu, ebe akwara gluteus minimus na-esitekwa na ilium wee gaferes minimus na-esitekwa na ilium wee gafere n'akụkụ azụ nke nkwonkwo hip ka ọ kwụsị n'akụkụ azụ nke nnukwu trochanter (Figures 2 & 3). Anụ ahụ abụọ a nta ụkwụ na �'ime ime nke hip. Ya mere, mmebi nke akwara nd�ullary femoral femoral ga-eme ka adịghị ike na-eme ihe na Trendelenburg gait, nke na-enwe mmetụta na-adịghị mma na mgbake na nsonaazụ onye ọrịa.

Fig. 2. Anatomi nke mọzụlụ gburugburu hip nkwonkwo

Ọgụgụ 3. mpaghara mgbakwunye akwara femoral dị nso

Yiri Femoral Intramedullary Ntu

Ọtụtụ nnyocha e mere n'oge na-adịbeghị anya enyochala ebe kachasị mma maka ntu femoral paracrine. Nhọrọ ntinye ntu gụnyere nnukwu trochanter na pyriform fossa, nke ọ bụla nwere ihe ngosi nke ya na nsogbu n�

Tebụl 1. mmalite mmalite na ihe ize ndụ ndị nwere ike ime nke paracrine na retrograde femoral nailing
iche iche	ntu intramedullary yiri ya		retrograde intramedullary ntu
	rotor	pyriform fossa (anatomy)
ụgbọ elu okpueze	Vertex nke nnukwu trochanter ma na-atụ aka n'etiti etiti oghere medullary	njikọ nke ukwuu trochanter na femoral olu	etiti nke intercondylar fossa (anatomy)
ụgbọ elu sagittal (mgbakọ na mwepụ)	Ahịrị n'etiti etiti nnukwu trochanter na etiti oghere ụmị nke femur	pyriform fossa (anatomy)	PCL 1.2 cm n'ihu na mmalite femoral, na-atụ aka na oghere medullary.
mkpughe	Ndị na-akụ hip na-akwụsị mmerụ ahụ	Mmebi nke inye ọbara n'isi femoral na akwara rotator mpụga hip	Ijikwa na-ezighi ezi nwere ike ibute PCL
PCL: eriri azụ cruciate

1.Large rotor agịga ntinye ebe

A kọwawo trochanter ka ukwuu dị ka ọkpụkpụ trapezoidal kachasị elu nke dị n'akụkụ akụkụ nke olu femoral, nke elu ya na-enye njikọ na mpụta gluteus medius na anterior gluteus minimus mọzụlụ (Figures 2 na 3). Ọ bụ ezie na nke a bụ obere akara ala ọkpụkpụ, ịkọwapụta ebe mmalite ziri ezi mgbe ị na-eme IMN femoral nwere ike ịbụ ihe dị iche n'inweta ihe na-eju afọ ma ọ bụ nke na-adịghị mma mgbe ị na-eme ihe mgbaji ụkwụ femoral.

N'ịtụle akwụkwọ ugbu a maka nkọwa ntinye ntinye femoral, anyị chọpụtara na enweghi akara ngosi nke ọma nke akọwara nke ọma maka ebe ntinye femoral rotor IMN.Bharti et al. kọwara ebe ntinye site na apical apex nke ukwuu trochanter dị ka medial n'ebe oghere medullary na orthostatic ọnọdụ, na dị ka ebe etiti nke nnukwu trochanter na akara na etiti nke femoral medullary cavity na mpụta ọnọdụ (Fig. 4), na nkọwa ọzọ nke nnukwu trochanter ntinye uche n'etiti akụkụ nke rotor na-eche ihu n'etiti akụkụ nke rotor-hip. na azụ ụzọ abụọ n'ụzọ atọ nke rotor.Georgiadis et al. kọwara ebe ntinye agịga dị ka akụkụ azụ kacha elu nke oke elu nke rotor.

Foto 4. Intraoperative orthostatic na n'akụkụ echiche nke hip na-egosi ebe ntinye dị mma maka femoral paramedian intramedullary nailing nke nnukwu trochanter. '*' na-egosi ebe ntinye ntu intramedullary.

Nnyocha ndị e mere n'oge na-adịbeghị anya na akwụkwọ ndị ahụ egosila na ọnụ ọgụgụ kasị elu nke trochanter bụ ebe kachasị mma maka ịnweta akara ike kachasị mma, na nkwụsịtụ na-adịghị mma n'ihi nrụrụ nrụrụ na-emekarị mgbe a na-atụgharị ihe ntinye ihe karịrị 2 mm n'akụkụ trochanter ka ukwuu. Ọmụmụ ihe a kwusiri ike na ebe ntinye dị n'azụ na-eduga n'ọpụpụ n'ihu, ebe ntinye etiti nwere ike ime ka ọkpụkpụ mgbaji dị anya ga-akwaga n'azụ. N'ụzọ dị iche, ọmụmụ ihe ọzọ gosiri na na intertrochanteric femur fractures, ihe omume nke ntu ntu intramedullary dị elu nke ukwuu na ntinye ntinye nke dị n'akụkụ ihu n'akụkụ ihu karịa ka ọ dị tal Fibula Plate-II

A na-ejikarị trochanteric apex pinning point na ndị ọrịa buru ibu, usoro a adịghịkwa achọ teknụzụ, na-enye obere oge ọrụ yana obere nsogbu nke nsogbu karịa pyriform fossa pinning point.

MKPA: Atụlela nsogbu intraoperative na postoperative nsogbu nke femoral intramedullary nailing na ukwuu trochanteric obibia nsoro a tụlere n'ọtụtụ akwụkwọ. Otu n'ime ihe ndị a, nke na-emetụtakarị usoro ntu, bụ mgbaji na-akpata ọgwụ. Na intertrochanteric femoral fractures, ebe ntinye nke dị n'akụkụ na n'ihu na trochanter ka ukwuu nwere ike ịkpata mgbawa etiti karịa ebe ntinye nso n'akụkụ etiti.

Mgbagwoju anya ọzọ dị mkpa bụ n'ihi mmerụ ahụ dị nro, karịsịa na alaka nke medial rotator femoral artery na muscle adductor, ma mmerụ ndị a adịghị adịkarị ma e jiri ya tụnyere pyriform fossa ntinye ntu. Na mgbakwunye, ihe omume nke ischemic necrosis nke isi femoral na ọnụ ọgụgụ nke trochanter ka ukwuu ka a na-eche na ntinye ntinye dị ntakịrị, na ọmụmụ na-akọwa ya dị ka 0.3%.

N'iburu n'uche oge intraoperative na ikpughe fluoroscopic, oge ọrụ pụtara bụ nkeji 90.7 maka ebe ntinye trochanteric ka ukwuu ma e jiri ya tụnyere nkeji 112.7 maka otu ntinye nke fossa dị ka pear, ebe oge fluoroscopic bụ 5.88 sekọnd maka nnukwu ntinye trochanteric na 10.08 sekọnd maka ntinye nke ụdị pear, ma e jiri ya tụnyere fossa.

Nleba anya nke onye ọrịa bụkwa ihe dị mkpa mgbe ị na-ekpebi ebe ntinye ntu intramedullary, dị ka mgbake na-arụ ọrụ n'oge (dị ka a na-enyocha ule oche oche na ule elu oge) dị nnọọ mma na ndị ọrịa na 6 ọnwa postoperatively maka nnukwu ntinye trochanteric ma e jiri ya tụnyere pyriform fossa ntinye ntinye ntu, ma ọdịiche a abụghị ihe dị ịrịba ama na ọnwa 12. Ọ bụ ezie na a na-ejikọta ọnụ ọgụgụ ka ukwuu nke trochanteric na nkwụsị anụ ahụ dị nro n'ihi ọnọdụ ya, ọ ka nwere ike ibute mmerụ ahụ n'ahụ ndị na-eme ihe ike, dị ka Ergiş et al gosipụtara. Ha chọpụtara na nguzozi ike na ike abductor hip belatara na ndị ọrịa nwere peg ntinye trochanteric ka ukwuu ma e jiri ya tụnyere njikwa ahụike. Tụkwasị na nke ahụ, ọmụmụ ihe ha kọrọ na mbelata dị ukwuu nke ike nke ndị na-agba ọsọ hip, ndị na-agbanwe agbanwe na n'ime / mpụta rotors ma e jiri ya tụnyere akụkụ na-adịghị arụ ọrụ.

2. Pelly fossa ntinye ebe

The fossa nke akwara pyriformis bụ ihe dị mkpa anatomical akara amata dị ka otu n'ime ntinye ntinye maka ntu intramedullary femoral paracentesis. N'ime nchọpụta cadaveric autopsy ha, Lakhwani et al. kwuru na fossa nke uru ahụ pyriformis abụghị nke akpụrụ akpụ ' ube' ma ọ bụ ihe mgbakwunye akwara pyriformis. Anụ ahụ na-ejikọta na obere mpaghara n'ọnụ ọnụ nke nnukwu trochanter, ebe pyriform fossa bụ ịda mbà n'obi n'akụkụ etiti nke nnukwu trochanter na bụ mgbakwunye nke extensor carpi radialis brevis muscle. Ndị ode akwụkwọ kwubiri na uru ahụ pyriform na pyriform fossa bụ ihe abụọ dị iche iche yana na ihe a na-akpọ pyriform fossa kwesịrị ka a kpọọ ya 'rotor' ma ọ bụ ' occlusal' fossa maka idoanya na nhazi nke anatomical. Ha tụrụ aro na mgbe ha mụọchara cis-femoral Ha tụrụ aro ka eweghachite okwu mbụ bụ́ 'rotor fossa' n'akwụkwọ kama ịbụ 'pyriform fossa' mgbe ha mụchara okwu nke ebe ntinye parafemoral. Ọ bụ ezie na a na-akwanyere isi ihe ọmụmụ abụọ a anya nke ọma, maka ịdị mfe nkọwa na iji gbochie mgbagwoju anya na ntinye trochanteric ka ukwuu, anyị ka ga-ezo aka na ntinye a dị ka ntinye pyriform fossa.

Ọtụtụ ọmụmụ na akwụkwọ ugbu a na-akọwa n'ụzọ ziri ezi kpọmkwem ebe ntinye nke pearly fossa maka intramedullary femoral mbọ.Georgiadis et al. kọwapụta ebe ntinye pearly fossa dị ka ebe a na-ejikọta extensor carpi radialis brevis muscle na ịda mbà n'obi na isi nke olu femoral (Fig 5). Ndị na-ede akwụkwọ kwusie nwere ike ime ka ihe ize ndụ nke mgbawa n'olu femoral, na mgbe ebe ntinye dị anya azụ azụ, enwere ike inwe nnukwu ihe ize ndụ nke necrosis ischemic, nke dị elu na ndị ọrịa nọ n'afọ iri na ụma.

Ọgụgụ 5. Intraoperative n'ihu ihu nke hip na-egosi ezigbo ntinye ntinye maka pyriform fossa retrograde femoral intramedullary mbọ. Ihe '*' na-egosi mmalite ntu intramedullary.

Harper et al. bipụtara ọmụmụ nke yị cadaveric femurs na 1987 bụ nke ha nyochara ọnọdụ nke intramedullary ndu pinwanyị cadaveric femurs na 1987 bụ nke ha nyochara ọnọdụ nke intramedullary ndu pin na ụzọ ọpụpụ nke ntu intramedullary ewepụtara distally na proximally na retrograde ejiji site na intercondylar notch nke femur. Ha kwubiri na ebe ntinye nke pyriformis paramedian intramedullary ntu dị na nkwụsị nke trochanter ka ukwuu na olu femoral, dị ntakịrị n'ihu na pyriformis occult. Ebe ntinye nke Gausepohl et al kwadoro ebe ntinye. N'ime nchọpụta cadaveric ọzọ, ha depụtara ebe dị mma maka ntu intramedullary femoral n'akụkụ etiti nke nnukwu trochanter na-ekpuchi akwara pyriformis. Ọzọkwa, na ọmụmụ cadaveric nke Labronici et al. A kọwara fossa nke akwara pyriformis dị ka mpaghara luminal nke yiri pear nke dabara na etiti etiti nke oghere intramedullary femoral na ụgbọ elu coronal.

Ebe ịnweta pyriform fossa nwere ụfọdụ ọghọm dị n'ihi na ọ na-esiri ike na teknụzụ karịa ebe ịnweta trochanter ka ukwuu, ọkachasị na ndị ọrịa buru ibu. Na mgbakwunye, ebe ntinye kacha mma maka ebe ntinye agịga fossa dị ka pear bụ ebe dị warara, na-eme ka ọ na-esiri ike ịkọwapụta. Dịka ọmụmaatụ, mmalite mmalite nke ukwuu n'olu femoral ga-ebute oke nrụgide gburugburu ma mee ka ohere nke mgbawa cortical dị n'ihu, karịsịa ma ọ bụrụ na mmalite dị karịa 6 mm n'ihu fossa. Tụkwasị na nke ahụ, ọdịiche morphologic nwere ike igbochi saịtị ntinye ziri ezi, karịsịa ma ọ bụrụ na rotator dị mkpirikpi dị n'èzí dị oke ma ọ bụ rotor na-apụta, na-eduga na saịtị ntinye nke dị oke etiti na ihe ize ndụ nke mgbawa olu femoral.

NKWUO: Site n'ịtụle saịtị ntinye trochanteric 38 ka ukwuu na saịtị ntinye pearly fossa 53 maka intramedullary femoral intramedullary nailing, Ricci et al chọpụtara na otu pearly fossa nwere oge ọrụ 30% ogologo oge yana 73% ogologo oge fluoroscopy. Bhatti et al kwadoro nchoputa ndị a. mgbe atụnyere ihe ntinye agịga 2.

Banyere mmerụ ahụ dị nro, enwere ihe ize ndụ dị elu nke mmerụ ahụ dị nro na ntinye pyriformis ta e jiri ya tụnyere in

Tebụl 2. Nchịkọta nke mmerụ ahụ dị nro na ebe ntinye agịga dị iche iche
iche iche	Ebe ntinye Pyriform fossa (n=5)	Nnukwu ebe nri rotor (n=5)
anụ ahụ dị nro
akwara gluteus medius (anatomy)	5	1
akwara gluteus medius	0	4
mmerụ ahụ akwara
gluteus minimus (anatomy)	3	0
pyriformis muscle (n'elu n'elu spain)	3	3
obturator internus (anatomy)	1	0
akwara latissimus dorsi (anatomy)	3	0
arịa ọbara na nkwonkwo capsules
MFCA Deep alaka	4	0
MFCA Shallow Alaka	4	0
capsule articular (nke nkwonkwo dị ka ikpere na anatomi)	1	0
MFCA: akwara etiti sekọmflex femoral.

Na nso nso a, Bharti et al. mụọ ihe egwu dị mgbagwoju anya nke intramedullary femoral nailing na ebe ntinye trochanteric ka ukwuu na ebe ntinye pearly fossa wee chọpụta ihe ize ndụ ndị dị mgbagwoju anya dị ka ọnụọgụ ọgwụgwọ mgbaji ma chịkọta ha dị ka ndị a (Table 3).

Tebụl 3. Pyriform fossa ntinye ebe na ebe ntinye trochanter ka ukwuu na ụmị ọkpụkpụ femoral
mgbagwoju anya	Piriformis sinus agịga	Ebe ntinye trochanter ka ukwuu
bute ọrịa	6.7	3.3
Maluion	20	13.3
Ọgwụgwọ egbu oge	20	13.3
Mgbanwe hip nwere oke	20	33.3
Ochichi ikpere ije	6.7	6.7
Ọdịiche ogologo aka	13.3	20
Okpu ọdụ na-apụta n'elu cortex ọkpụkpụ	13.3	20
Intraoperative femoral olu mgbaji	10	0
Ọkpụkpụ trochanter ka ukwuu	0	3.4
Femoral isi necrosis	6.7	0

Retrograde femoral intramedullary ntu

Ịchọpụta ebe ntinye kwesịrị ekwesị maka ntugharị femoral femoral intramedullary ga-enyere aka nweta mweghachi nke nhazi mgbaji kachasị mma, ogologo oge na ntụgharị mgbe ị na-ebelata mmebi nke cartilage, ọkpụkpụ azụ azụ (ACL), ọkpụkpụ azụ cruciate ligament (ACL), na mmerụ anụ ahụ dị nro (Table 1). N'oge na-adịbeghị anya, a na-enwe mmasị na-arịwanye elu na ntanye intramedullary femoral femoral na ebumnuche nke ibelata nsogbu ndị metụtara paracromial nailing, gụnyere mgbu hip, heterotopic ossification, adịghị ike adductor, na pudendal nerve palsy, nke a na-ewere na ọ dị ntakịrị mkparị ma e jiri ya tụnyere mbelata mbelata na ikpochi femoral plating n'ime ime ime - nke a na-etinye n'ime ime n'ime ime na imechi femoral plating. femoral azuokokoosisi. Tụkwasị na nke ahụ, ihe àmà na-adịbeghị anya na-egosi na mgbe ntu ndị a na-emeghachi azụ intramedullary dị nha nke ọma, a gaghị achọ mbọ mkpuchi dị nso. Ọ dịghị ihe dị iche na ọnụego ọgwụgwọ, oge na-agwọ ọrịa, ma ọ bụ onye ọrịa na-akọ n'etiti Meccariello et al. na Bisaccia et al. na ọgwụgwọ nke distal otu ụzọ n'ụzọ atọ femoral stem fractures na-eji mkpọchi na nonlocking retrograde intramedullary mbọ. Ya mere, iji retrograde femoral nailing aghọwo ihe a ma ama na nke a nabatara n'ọtụtụ ebe.

Enwere ike ịchọta ọtụtụ nkọwa nke ebe ntinye kacha mma maka ịcha mbọ intramedullary femoral retrograde na akwụkwọ. Ọtụtụ ọmụmụ na-achọpụta ebe ntinye dị mma maka ntu femoral retrograde dị ka 1.2 n'ihu na mmalite femoral nke azụ cruciate ligament.

cm (n'ahịrị na oghere medullary) na etiti nke intercondylar fossa (Fig 6).

Foto 6. Intraoperative orthostatic na n'akụkụ echiche nke ikpere na-egosi ebe ntinye dị mma maka ntu intramedullary femoral femoral retrograde. '*' na-egosi mmalite ntu intramedullary.

N'agbanyeghi na enweghi ihe ngosi zuru oke maka ntu intramedullary femoral femoral, a kọwawo ọtụtụ ihe ngosi. Ndị a na-agụnye ndị ọrịa polytrauma, ndị ọrịa na-arịa ọrịa na-adịghị mma, ndị ọrịa dị ime, ọkpụkpụ femoral femoral bilateral, ipsilateral femoral stem na acetabular / pelvic fractures ma ọ bụ femoral olu fractures, na ipsilateral femoral stem na tibial fractures. Ọtụtụ n'ime ihe ngosi ndị a metụtara ịdị mfe nke ọnọdụ onye ọrịa na mgbochi nke ọtụtụ ọnya ịwa ahụ na nso nso.

N'aka nke ọzọ, contraindications zuru oke na ntu intramedullary femoral femoral gụnyere mgbochi nke ọwa intramedullary retrograde site na ntinye na-ejigide ya na mgbaji meghere nke femur dị anya. contraindications ndị ikwu bụ mgbaji dị n'ime 5 cm nke obere trochanter, ọ na-esiri ike ịnweta ebe ntinye kacha mma n'ihi mgbatị ikpere nke na-erughị ogo 45, ọrịa ikpere ikpere tupu nke nwere ike iduga n'ihe ize ndụ nke ịgbasa na stem femoral, mmerụ ahụ dị nro dị nro n'akụkụ ikpere, na ọkpụkpụ intra-articular nke ọkpụkpụ azụ na-adịghị mma.

Mgbagwoju anya: Ọtụtụ nsogbu nke ntu femoral retrograde na-ejikọta na njikwa na-adịghị mma, karịsịa ntinye ebe ntinye ezighi ezi. N'ime ụgbọ elu sagittal, ebe ntinye ihu n'ihu ga-eme ka nsụgharị mgbaji dị n'azụ, mmebi elu nke articular, na ikekwe ntu ntu na patella mgbe ikpere na-atụgharị. N'aka nke ọzọ, ọ bụrụ na ntinye ntinye na-ekwesịghị ekwesị n'akụkụ azụ, nke a nwere ike ime ka ọ bụrụ ihe ize ndụ dị elu nke mmerụ ahụ na mmalite nke cruciate ligament na mbupụ n'ihu nke ebe mgbawa ahụ.

tchinson et al. kọwara nsogbu ndị metụtara ebe ntinye ụgbọ elu coronal na-ezighi ezi. Ha chọpụtara na nr�bu ndị metụtara ebe ntinye ụgbọ elu coronal na-ezighi ezi. Ha chọpụtara na nrụrụ dị nhịahụ nke ukwuu butere nrụrụ dị n'azụ ya na ntụgharị mgbawa n'azụ, ebe akụkụ nke ukwuu butere nrụrụ etiti � ntụgharị ntụgharị.Sanders et al. kọrọ na ịhọpụta mmalite mmalite nke dị 2 cm ma ọ bụ karịa site na etiti etiti ahụ mere ka ọkpụkpụ cortical na-�me ka ọkpụkpụ na-eme ka ọ bụrụ nke na-adịghị mma n'ihi oge na-ehulata azụ nke isthmic na-eme ka ọkpụkpụ na-eme ka ọkpụkpụ na-adịghị mma.

Nsogbu ndị ọzọ jikọtara ya na ntu na-eso femoral femoral retrograde gụnyere mgbu ikpere, isi ike, heterotopic ikpere ossification, na intra-articular ikpere n'ụdị ahụ n'efu.

mechie

Ọ bụ ezie na usoro ntu aka nke ọ bụla nwere ihe ngosi kwekọrọ, nhọrọ nke usoro ntu intramedullary a ga-eji na-agwọ ọrịa ọkpụkpụ femoral na-adaberekarị na mmasị dọkịta na-awa ahụ. Mgbe ị na-arụ ọrụ intramedullary nailing nke femur, ịnweta ebe ntinye ziri ezi maka ụdị ntu a na-eji maka ndozi dị mkpa maka ihe ịga nke ọma. Ịmata ihe gbasara ahụmịka mpaghara na ịrụ ọrụ onyonyo ga-enyere onye dọkịta na-awa ahụ aka ịrụ usoro zuru oke nke teknụzụ ma na-ebelata ihe ize ndụ nke nsogbu ndị metụtara ya. Na mgbakwunye, na usoro ntu intramedullary, mmezi nke mbelata bụ ihe dị oke mkpa n'igbochi ajọ ọrịa na nhụsianya ma ọ bụ enweghị njikọ nke mgbaji.