Carbon fiber implant in orthopedic oncology

9 intraoperative fluoroscopic views show steps towards antegrade cephalomedullary nailing of the right femur. The start point at the greater trochanter was identified. After reaming, the intramedullary nail was placed. The intramedullary nail is radiolucent but is associated with a radiopaque longitudinal metallic liner that spans its entire length. The femoral head and neck were then drilled and a guide pin was placed, which was confirmed to be centrally positioned on both AP and lateral views. The guide pin was reamed and a cannulated proximal lag screw was placed. The lag screw is coated in its threaded portion with an ultra-thin titanium shell for better visualization. The radiopaque marker at the tip of the lag screw is within the femoral head. A set screw was then inserted and tightened. Two traditional metallic threaded distal interlocking screws were then placed through the screw holes which are bracketed by reference dots (4 dots for each hole on the AP view and 2 dots for each hole on the perfectly aligned lateral view). The proximal end of the nail incorporates a radiopaque marker and is aligned with the top of the greater trochanter. No nail cap was added in this case (which typically has two radiopaque markers).

AP and lateral radiographs of the right femur show prophylactic cephalomedullary nailing of the right femur with radiolucent carbon fiber femoral nail. Associated metallic liner extends through the majority of the femur. There is a proximal lag screw, set screw, and two traditional metallic distal interlocking screws. All components are intact and correctly positioned. There is heterotopic ossification along the superior aspect of the greater trochanter. Atherosclerotic calcification is noted. A soft tissue defect is apparent at the anterolateral aspect of the mid thigh related to prior sarcoma resection.