Use of novel and inexpensive radiolucent soft tissue protector for insertion of proximal locking screws in femoral retrograde intramedullary nailing

Abstract We use a straightforward technique for insertion of proximal interlocking screw fixation during retrograde intramedullary nailing of the femur utilizing a common 3 cc syringe as a radiolucent soft tissue protector. Following insertion of the implant and distal interlock insertion, the distal Luer-Lok tip of a 3 cc syringe is cut off to create a hollow tube. Once the correct location of the proximal locking holes is confirmed fluoroscopically, the syringe is inserted through the incision into the soft tissue over the long drill sleeve and trochar. The inner drill guide and trochar is then removed, leaving only the syringe. Through this syringe, the proximal interlocking hole is drilled and measured, and the screw is inserted. The syringe establishes a safe pathway for passage of instrumentation, mitigating damage to the surrounding soft tissues, and allowing for unobstructed fluoroscopic visualization throughout insertion of the locking screws. This technique is safe, inexpensive and reproducible; utilizing common equipment available in most operative settings.