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9Securing the proximal fragment

Reduction of the proximal femoral shaft with the pull reduction instrument

With the help of the pull reduction instrument, secure the desired position of the shaft, in relation to the LISS plate. This is an important step because otherwise some displacement may occur during the insertion of self-drilling/self-tapping screws. (Note: this instrument has a 4.0 mm diameter which still allows for the insertion of a 5.0 mm locking-head screw into the same hole later on.)

Attach a syringe, filled with saline, to the drill sleeve to provide cooling during the bone drilling procedure.

The pull reduction instrument is self drilling and self tapping. It is inserted through a sleeve that has been placed in the appropriate hole in the insertion guide and has been advanced through a stab incision. The pull reduction instrument is inserted using a power tool but great care is needed, using an image intensifier, only to engage the threaded portion into the bone. Over-insertion will strip its thread in the bone.