Femoral Nail Insertion (Stryker)

Femoral Nail Insertion

The femoral nail insertion using the Stryker system is a standard orthopaedic procedure to manage femoral shaft fractures. As a scrub nurse in Australia, your preparation is critical — including knowing the correct positioning, implants, instrumentation, and surgical flow.

Relevant Anatomy

This procedure involves the femoral shaft, trochanteric region, and distal femur. Understanding anatomical landmarks for entry point and imaging is essential.

1. Instruments and Equipment Checklist

Stryker Femoral Nailing System Tray

• Guidewires and trocars
• Entry awl and cannulated drill
• Reaming system
• Femoral nails (lengths and diameters as per plan)
• Targeting arm for distal locking
• Locking screws (proximal and distal)
• Depth gauge and screwdrivers
• Power drill and battery
• Fluoroscopy (C-Arm) access
• Skin hooks, retractors (e.g., Hohmann), bone clamp

Consumables and Implants

• Stryker Femoral Nail (plan both length and diameter options)
• Distal and proximal locking screws (confirm sizes pre-op)
• Radiolucent drapes and iodine drapes
• Antibiotic irrigation solution

Sutures

• 2-0 Vicryl for deep closure
• 3-0 Monocryl for subcuticular
• Staples or glue (surgeon preference)

2. Preoperative Preparation

1. Ensure correct surgical side is marked and confirmed with x-rays
2. Prepare the Stryker nail system according to surgeon’s selection
3. Position patient on traction table (fracture table) with foot secured
4. Attach C-Arm for intraoperative imaging; test positioning
5. Scrub nurse to set up all trays, confirm count and instruments ready

Patient Positioning

• Position: Supine with affected leg in traction, other leg abducted
• Support: Perineal post and boot traction device
• Arms: On arm boards or crossed over chest (well-padded)
• Imaging: C-arm must be able to access from hip to knee

Skin Preparation and Draping

• Prep from nipple line to toes of affected leg
• Use betadine or chlorhexidine solution depending on policy
• Drape with extremity drapes or clear iodine adhesive drape plus sterile sheet

3. Intraoperative Steps (Stryker Technique)

1. Confirm fracture reduction under image intensifier
2. Incision made at greater trochanter area
3. Entry awl and guidewire insertion
4. Sequential reaming of the canal
5. Insert chosen femoral nail
6. Attach targeting jig for locking screws
7. Insert proximal and distal locking screws (freehand or jig guided)
8. Confirm final construct under fluoroscopy
9. Irrigation and closure in layers

4. Post-Operative Tasks

• Final count confirmation
• Remove drapes and assist patient transfer
• Ensure all implant details are recorded correctly in documentation
• Send any removed bone fragments to pathology if applicable
• Handover to recovery with neurovascular observations and implant info