Guide Wire Entry and Placement

Femur models help residents visualize the intercondylar notch as the entry point. Using foam models, residents can practice using the femoral nail system's entry reamer. Proper insertion of guidepin and placement of guidewire using manual force can be practiced repetitively to enhance procedural precision. 

Reduction

Femur fracture models help demonstrate proper reduction techniques using pull traction. Foam models facilitate practice in placing guidewire through the fracture site using the femoral nail system. 

Instruction can emphasize techniques in dealing with difficult fractures such as the use of special fracture reducers and pins to enable wider reaming. 

Reaming

Foam models help familiarize residents with different tool sizes used to ream the intramedullary canal. Best practices such as reaming in increments and avoiding reamer head incarceration can be further discussed.  

Nail Assembly

Residents can use a femur model to test their proficiency in properly assembling a retrograde nail in preparation for fixation. Manipulation of femoral nail system tools such as the driver nose, targeting arm, and drills can also be practiced on a foam femur model. 

Nail Insertion and Fixation

Foam models let surgeons acquire proper femur fixation techniques through repetitive practice. These include holding the nail's handle instead of the targeting guide during insertion. Another technique is to carefully advance the nail to avoid the development of new fracture lines in the bone. The use of a mallet or manual force can be tried on foam models during fixation. Proper countersinking of the nail using the femoral nail system guide can also be emphasized. 

Best practices such as seating the nail fully and using a lateral radiograph to assess insertion depth can be discussed using femur models. 

Screw Placement

Again, foam models help test residents' proficiency in choosing the right screw length, assembling, and inserting the screw using the femoral nail system. Foam models are suitable for practicing drilling and screw placement. The use of different drill bits and screw sizes can be demonstrated on the model. Techniques such as quick drill removal and screw insertion, tracking of the screw head, and evaluation of the procedure can be demonstrated using models. 

Locking

Freehand techniques for proximal locking can be practiced on femur models. The use of targeting devices to lock the nail can also be demonstrated. Foam cortical models are suitable for drilling when practicing proximal locking. Proper use of femoral nail system targeting tools and guides during locking can be demonstrated on plastic or foam femur models. 

Nail Removal

After successful union, femoral nails often need to be removed. Foam models again assist in training residents in proper extraction using a femoral nail system. Best practices such as preventing nail rotation, use of guide wire, and proper extraction technique can be demonstrated on a foam femur model.