Abstract: An all-mechanical system for bone-drilling alignment of a blind distal bone-screw hole of an installed intra-medullary nail, wherein the system provides (i) a drill jig that features a longitudinally adjustable nail-contactable contact-rod mounting in the jig and (ii) a drill-guide which can align with the blind distal bone-screw hole for a correct nail-contactable adjustment of the contact rod. The system enables the surgeon to check-out the drill jig in assembled relation to a selected intramedullary nail, prior to nail installation, and to perform an adjustment to compensate for nail diameter when the contact end of the rod engages the nail. He can then either visually satisfy himself of the drill-guide/bolt-hole alignment, or he can use a plug-gage or trocar tool having guidance in the drill guide, and checking for whether the plug gage has entry into the bone-screw hole in the intramedullary nail.

Abstract: A method for manufacturing a lateral bore in a tubular bone for a bone nail to be guided through a transverse bore of a bone nail characterised by the following features;knocking in the bone nailintroducing an elongate transmitting unit for energy into the bone nail and aligning an effective end of the transmitting unit, directed transversely to the axis of the nail, to the transverse bore in the bone nail;producing a hole which is relatively small in diameter by way of the effective end from the inside anddrilling out the small hole from the outside, preferably to the core diameter of the bone screw.

Abstract: In a method of making an entry hole for implanting a retrograde humeral nail across a fracture in a humerus comprises the initial step of providing a pin placement guide having a base with a bone contact surface and a guide portion attached to the base. A guide bore with a guide axis extends through the guide portion and the bone contact portion of the base. The pin placement guide is clamped on the humerus so that the guide axis is at a relatively small angle of less than 20.degree. with respect to the bone axis of the humerus, and the bone contact surface is substantially aligned with the bone axis. Next, a guide pin with a tip is inserted through the guide bore. A guide hole is bored into the bone along the guide axis with the guide pin. Next, the clamp and pin placement guide are removed. Finally, the guide hole is reamed to enlarge it into an entry hole that is at an angle with respect to the bone axis equal or less than that of the guide axis.

Abstract: There is presented a drill guide assembly for forming a transverse guide hole in a bone, the guide hole being adapted to receive a transverse screw, the guide hole intersecting a tunnel formed in the bone and adapted to receive a body to be retained in the tunnel and to receive the screw transversely of the body to secure the body in the tunnel. The drill guide assembly comprises a track member of an elongated curved configuration, the track member having a bore extending widthwise therethrough, and a curved slide track extending lengthwise thereof, a boom member having a first portion of an elongated curved configuration slidably disposed in the slide track of the track member, and a second portion for retaining a drill bit.

Abstract: A microdrive apparatus useful in human stereotactic surgery is disclosed. Such apparatus permits safe and accurate placement of a surgical instrument, such as a cannula, into a portion of the central nervous system, e.g. the brain and spinal cord, of a patient by simple mechanical operation.

Abstract: The milling instrumentation of this invention provides a milling guide connected to the femur for accommodating a milling device. The milling instrumentation includes an alignment guide which is used by the surgeon to set a femoral bracket or base on the medial and lateral sides of the exposed femur adjacent its distal end. Once the brackets are set, the alignment guide is removed and a milling guide is connected to the bases. The milling guide establishes a series of reference planes each including a slot. A powered milling device having a burr connected thereto is guided by the slots along the reference planes to accurately mill away a portion of the bone. The milling device includes a bobbin-shaped tip which positively engages the slots to ensure that the milling device is held substantially perpendicular to the reference planes of the milling guide.

Abstract: An all-mechanical system for bone-drilling alignment of a blind distal bone-screw hole of an installed intramedullary nail, wherein the system provides (i) a drill jig that features a longitudinally adjustable nail-contactable contact-rod mounting in the jig and (ii) a drill-guide which can align with the blind distal bone-screw hole for a correct nail-contactable adjustment of the contact rod. The system enables the surgeon to check-out the drill jig in assembled relation to a selected intramedullary nail, prior to nail installation, and to perform an adjustment to compensate for nail diameter when the contact end of the rod engages the nail. He can then either visually satisfy himself of the drill-guide/bolt-hole alignment, or he can use a plug-gage or trocar tool having guidance in the drill guide, and checking for whether the plug gage has entry into the bone-screw hole in the intramedullary nail.

Abstract: A surgical aiming instrument for a lining and guiding a piercing tool used to make a tunnel through a tibia which intersects two predefined points of the knee joint includes at its distal end a tip to be temporarily inserted in the bone. The instrument further includes means for positioning the instrument relative to the second of the predefined points. A second hollow member in line with the first member and defining therewith an axis X--X is also provided. The instrument further includes a flat arm connecting the first and second members as well as a handle. The tip is on the axis of the second member. A method of preoperative determination of isomeric attachment points includes the steps of taking two x-rays of the knee, one in an extended position and one at 90.degree. of flexion, superimposing the x-rays, and marking various points and lines thereon from which the isomeric attachment points may be determined.

Abstract: In a method of making an entry hole for implanting a retrograde humeral nail across a fracture in a humerus comprises the initial step of providing a pin placement guide having a base with a bone contact surface and a guide portion attached to the base. A guide bore with a guide axis extends through the guide portion and the bone contact portion of the base. The pin placement guide is clamped on the humerus so that the guide axis is at a relatively small angle of less than 20.degree. with respect to the bone axis of the humerus, and the bone contact surface is substantially aligned with the bone axis. Next, a guide pin with a tip is inserted through the guide bore. A guide hole is bored into the bone along the guide axis with the guide pin. Next, the clamp and pin placement guide are removed. Finally, the guide hole is reamed to enlarge it into an entry hole that is at an angle with respect to the bone axis equal or less than that of the guide axis.

Abstract: Osteosynthesis auxiliary (10) for the treatment of subtrochanteric, peritrochanteric and femoral-neck fractures, with a locking nail (12) that can be introduced from the proximal end into the medullary space of a femur (11) and that comprises a distal section (15) having at least one oblong cross bore (13) to receive a distal locking element as well as a proximal section (14) having a slanted passageway (16), and with a femoral-neck part (19) that can be introduced from a lateral position through the slanted passageway (16) into the neck (17) and head (18) of the femur, wherein at least the section of the femoral-head part that can be anchored in the head (18) of the femur has a cross section that is not circular or rotationally symmetrical. Preferably this section (34) has the shape of a double-T or I profile (35).

Abstract: A magnetic positioning system is provided for assisting in positioning a fastening element at a desired concealed internal location such as in a preformed opening in an interlocking nail in a long bone of a limb of a patient who has suffered a bone fracture. The arrangement includes: a first permanent ("target") magnet positioned at the internal location and a positioning device for a second permanent ("targeting") magnet. The positioning device comprises a hand-held drill and a magnetic aiming device mounted on the drill. The aiming device including a pivot member including the second magnet is disposed at one end thereof and having an axial bore. A mount for the pivot member permits three degrees of movement of the pivot member so as to enable the second magnet to align with the first magnet. The positioning device also includes a guide pin which is insertable into the axial bore and which is engaged by the drill chuck of the drill when the magnets are aligned.

Abstract: A bone-cutting guide having a base with a cylindrical tunnel for guiding a cutting instrument therethrough. The guide is anchored to the bone in at least three locations. A positioning arm having a distal end anchors the guide within a joint. An anchoring pin is insertable through the base alongside the cylindrical tunnel to stabilize the guide against the bone being drilled. An embodiment of the invention includes two anchoring pins on either side of the cylindrical tunnel through the base. The positioning arm can be stabilized within a joint due to stabilizing spikes extending from the distal end of the arm. A curve is provided in the positioning arm between two spikes to provide an opening through which a reamer guided through the cylindrical tunnel maybe operated.

Abstract: A medullary cavity template has a tubular body adapted to the shape of a medullary nail. The tubular body has one or more x-ray viewable discontinuities in the region of its distal end. The tubular body also has a scale in the region of its proximal end, the scale being on the outside of the body for external viewing to measure axial depth of a medullary cavity.

Abstract: An intramedullary nail inserting and mounting instrument includes a base portion which can be mounted to one end of an intramedullary nail inserted in bone marrow of a pair of bone pieces of a fractured bone to be interconnected, a guide shaft portion which is integrally provided on the base portion and which extends in the direction of an extension of the intramedullary nail, a pressing member which is movable along the guide shaft portion to come into contact with one end of one of the bone pieces, and a pressing member moving device which moves the pressing member along the guide shaft portion. The disclosure also addresses a method for inserting and securing the intramedullary nail to the fractured bone using the mounting instrument.

Abstract: The present invention is directed to microdrive apparatus useful in human stereotactic surgery. Such apparatus permits safe and accurate placement of a surgical instrument, such as a cannula, into a portion of the central nervous system, e.g. the brain and spinal cord, of a patient by simple mechanical operation.

Abstract: A blind-hole locating system wherein a drill jig, which is to be removably attached to the proximal end of a given intramedullary nail, incorporates outrigger structure for support and orientation of one or more drill guides, such that positioning and alignment with one or more bone-screw holes of the nail can be checked and ascertained as a preliminary step, and such that a precise spacer or stabilizer carried by this jig can be known to contact the nail, on an alignment transverse to the nail and to a geometric plane which includes the nail axis and the axis of at least one of the bone-screw holes of the nail, such stabilizer contact being achieved only for the case of correct drill-guide alignment with one or more bone-screw holes.

Abstract: A bone drill guide having at least a first arm slidable within a bore of the body of the drill guide and a ratchet mechanism for locking the first arm and the first bore. The ratchet mechanism includes teeth on the first arm and a pawl biased along a first axis and having a continuous engagement edge for engaging the teeth of the first arm for any angular orientation of the pawl about the first axis. The continuous engagement edge is a curve in a plane transverse to the first axis for providing a substantially renewable point contact with the teeth. The recess includes side walls tapered towards the engagement edge to allow a narrow contact at the engagement edge and re-enforce face walls to absorb the axial forces of the guide.

Abstract: Apparatus and methods for detecting the location of transverse holes of an intramedullary nail which has been inserted into a long bone and for aligning a surgical drill to the transverse holes. An insert having a light source at its distal end emitting non-ionizing electromagnetic radiation in the visible spectrum or infrared is inserted into the intramedullary nail, such that the light source is placed adjacent to the transverse holes. The light source may be a directional radiation output emitting the radiation in a direction perpendicular to the axis of the intramedullary nail. The light source may alternatively be an isotropic radiation output emitting radiation in all directions. The surgeon detects the transmitted radiation on the surface of the body of the patient and aligns the drill with the emitted radiation. Auxiliary video equipment, such as a camera and video monitor may be used to collect and display the emitted radiation, particularly if light in the infrared portion of the spectrum is used.

Abstract: A magnetic positioning system is provided for assisting in positioning a fastening element at a desired concealed internal location such as in a preformed opening in an interlocking nail in a long bone of a limb of a patient who has suffered a bone fracture. The arrangement includes: a first permanent ("target") magnet positioned at the internal location and a positioning device for a second permanent ("targeting") magnet. The positioning device comprises a hand-held drill and a magnetic aiming device mounted on the drill. The aiming device including a pivot member including the second magnet is disposed at one end thereof and having an axial bore. A mount for the pivot member permits three degrees of movement of the pivot member so as to enable the second magnet to align with the first magnet. The positioning device also includes a guide pin which is insertable into the axial bore and which is engaged by the drill chuck of the drill when the magnets are aligned.

Abstract: Apparatus for inserting pins in osseous material by vibration. The apparatus has a fixed housing with a cavity for moving the pins therethrough. At the proximal end the housing has a clamping device which operates in one direction. Vibration means inside the housing impose vibrations on the pin to insert them into the osseous material.

Abstract: A compression interlocking system for stabilizing shoulder fractures comprises an elongated intramedullary rod for extending within a bore generally parallel to the longitudinal axis of the humerus from the proximal end of the humerus to beyond the fracture, a pair of proximal transverse bores in the rod for positioning proximate the fracture, and a pair of proximal lag screws for extending across said fracture and through said transverse bores.

Abstract: A targeting device for making holes in cortical bone for bone nails has a right angle drill which interconnects to a telescopic guide member. The guide member attaches to the drill at the side thereof opposite the chuck. The free end of the telescopic guide attaches to an X-ray machine and maintains the drill in position during the drilling operation. A manual targeting device is used to locate bores in the bone nail and to spot drill the bone. The aligned telescopic guide is then used to complete the drilling operation.

Abstract: An all positional and universal guiding device for interlocking intramedullary nail is provided with a locating seat which is movably disposed at an outer end of the handle of an osteopathic intramedullary nail. The locating seat has one side which is parallel to the intramedullary nail and provided thereon with an adjustment device and an outer locating rod. The intramedullary nail and the outer locating rod can be kept relatively at precise position by means of the multi-sectional universal adjusting blocks for achieving an all-bearing adjustment and for drilling a locking screw hole rapidly.

Abstract: An improved drill guide device is provided for accurately drilling a passageway through bone. The drill guide comprises a support, a curved radial rack, a locator boom movably disposed on the curved radial rack, a drill sleeve and an indexing mechanism. The drill sleeve may be discretely indexed toward the target bone and locked/unlocked in position with a single handed operation.

Abstract: A jig is detachably secured to the proximal end of an installed intramedullary nail having a transverse bolt hole near the distal end of the nail. The jig comprises an offsetting arm which so mounts the proximal part of hinged elongate template structure as to render the distal part thereof angularly movable in a geometric plane substantially parallel to the nail. One or more spaced guide bores near the distal end of the movable distal part is on an axis perpendicular to the geometric plane. When the jig is chucked to the nail, the axes of the one or more guide bores of the template are parallel to the axes of one or more bolt holes of the nail; and corresponding guide-bore axis and bolt-hole axes are at identical distance from the offsetting arm.

Abstract: A drill guide and method for guiding placement of external fixation pins in the bone of a human limb to avoid an implanted intramedullary nail with the drill guide having a plurality of guide holes adapted to guide and receive a bone drill bit and bone pins. The drill guide also includes connecting for connecting the drill guide to one end of a drill guide handle connected to an intramedullary nail implanted in the bone and for aligning the guide holes in a fixed position relative to the nail so that the hole centerlines are oriented to avoid the nail.

Abstract: A drill guide is provided for aligning and installing a transverse pin through a tunnel formed by a tunnel drill in a bone to secure a ligament replacement to the bone. The drill guide includes an arm member and a drill guide sleeve coupled to the arm member. The drill guide sleeve is formed to include a central bore for guiding a drill to form a transverse guide hole in the bone to guide insertion of the transverse pin into the bone. The central bore of the drill guide sleeve has an axis which is aligned to intersect the tunnel. The arm member of the drill guide is coupled to the tunnel drill while the tunnel drill is still in the bone to align the arm member and drill guide sleeve at a desired anatomical location using the tunnel drill in the bone as a reference.

Abstract: An apparatus for the fixation of a bone and a method for locking an intramedullary nail. The bone has a medullary canal for use with an intramedullary nail that has been inserted into the medullary canal, the intramedullary nail having a longitudinal axis and distal and proximal ends and apertures in the ends. It essentially comprises a first member in the form of a sliding tubular member, a compression assembly, a guide member and an alignment fixture. The first member is in the form of an elongated first element having first and second ends, a central aperture, and a longitudinal axis aligned with the longitudinal axis of the intramedullary nail. The first end engages the bone adjacent the proximate end of the intramedullary nail. The compression assembly bears against the second end of the first element and applies compressive force to the bone through the first element. The guide member is disposed parallel to and spaced apart from the intramedullary nail; it has a proximal end and a proximal aperture.

Abstract: A method is provided for anchoring a replacement ligament in a bone. The method includes the steps of drilling a first hole through the bone with a drill to form a ligament tunnel, and drilling a second hole in the bone at an angle relative to the ligament tunnel using the drill inside the ligament tunnel as a reference to establish the position of the second hole. The method also includes the step of inserting a transverse pin through the second hole to secure the replacement ligament to the bone.

Abstract: A medical instrument and procedure mills a groove at a precise angle and location in a partially formed bone canal that has been drilled and reamed to provide a frustoconical seat for a prosthesis stem that has a conical proximal region. The groove finishes preparation of the canal in a precise manner so that an anti-rotation lug attached to the conical proximal region of the prosthesis stem seats in the finished canal accurately.

Abstract: A targeting device for implant to be used for fractures having a head that has a device for retaining a nail that will be inserted into a medullary canal of a bone, a locking device for releasably fastening the nail to the device for retaining the nail. A targeting arm attached to the head of the nail, wherein the targeting arm has an axis and a free end and it extends substantially parallel to nail.

Abstract: A drilling system for ACL reconstruction including: a first drill guide having an aimer member with a notched top surface for mating with the roof of the intercondylar notch; a positioning member having a removable drill guide sleeve; and a second drill guide including a second aimer member with a curved tip and a top notch. The positioning member can be placed on both drill guides for properly positioning the drill guide sleeve for the drilling of both the tibia and the femur.

Abstract: The invention is in a double guide sleeve drill guide for use in an arthroscopic surgical procedure for replacement of a cruciate ligament in a straight ligament tunnel procedure that involves forming intersecting tunnels to the femoral and tibial sections of which straight ligament tunnel. The drill guide of the invention includes straight parallel reference and guide rods that are in the extend from a web member at right angles and are in the same plane, forming a U-shaped device, with the reference rod arranged for fitting into which straight ligament tunnel. The connection of which reference rod to the web member is adjustable along the web member for setting a spacing distance between which reference and guide rods, and equidistant markings are scribed along the reference rod as a scale.

Abstract: An adjustable drill guide for use with an orthopaedic implant having sleeves which are adjustable to accommodate misalignment of the sleeves relative to the bores within a prosthetic implant. Each sleeve is press fitted within a retaining ring. The retaining rings are carried within a longitudinal slot of the extending leg of the guide. The rings may be clamped against movement after adjustment of the sleeves.

Abstract: An intramedullary intertrochanteric fracture fixation appliance comprising an intramedullary rod having an angulated opening to receive a femoral neck screw, said rod having a co-axial bore extending into said angulated opening, anti-rotation means located in said bore to selectively prevent rotation of said neck screw in the rod and the open end of said bore being provided with means to positively locate a removable fitting device on the proximal end of the rod and so that said anti-rotation means can be operated with the fitting device in position.

Abstract: A femoral tunnel entry drill guide for drilling a transverse hole from the side of a patient's knee to intersect a femoral section of a bony ligament tunnel formed in an arthroscopic surgical procedure. The drill guide of the invention has spaced apart parallel reference and external rods, an end of each connecting to ends of a web member forming a U-shaped device, the opposite rod ends bent at equal arcuate angles from the rod longitudinal axis. Each rod bent end has a transverse hole formed laterally therethrough, which holes align, and the external rod bent end transverse hole is threaded to receive a guide sleeve turned therethrough that has a straight bore for receiving a drill turned therethrough. Which reference rod bent end includes a longitudinal slot formed form the rod end to intersect the transverse. The reference rod bent end is fitted through a port formed through the skin of the knee, below the patella, and into the femoral tunnel section end in the intra articular joint.

Abstract: An attachment wire construction for attaching bone together, including an elongated wire having a leading end defining a drill tip. The wire has an anular breakneck groove that forms a reduced diameter frangible section. The leading end of the wire is externally threaded along the length of the wire.

Abstract: A drill guide for drilling a tunnel in a tibia for anterior cruciate ligament replacement comprises a target hook having a point for engaging and determining the exit of the tunnel in the tibial plateau, and a handle carrying a drill guide sleeve holder and selectively variable means for adjusting and rigidly fixing the angular position of the holder relative to the plateau. The drill guide also comprises a drill sleeve longitudinally selectively adjustably received in the holder for axial movement toward and away from the point, the drill sleeve having a proximal end extending toward the point. The drill sleeve is cannulated to receive a guide wire with a sharpened point headed toward the point. Engagement means for holding the drill sleeve in a selected position is provided, thereby preselecting the desired tunnel length defined between the proximal end of said drill sleeve and the point.

Abstract: An orthopaedic surgical implant apparatus includes an elongated intramedullary rod assembly 10 for use in uniting a pair of bone segments wherein each of the bone segments includes a medullary cavity. The elongated intramedullary rod assembly 10 defines a central longitudinal axis when assembled and includes first and second points of attachment 26, 48, the rod assembly 10 being adapted to be positioned within the medullary cavities of the bone segments and secured to the first bond segment at the first point of attachment 26 and to the second bone segment at the second point of attachment 48. Structure 18, 52 is provided for shortening the predetermined distance between the first and second points of attachment 26, 48 of the rod assembly in the direction of the longitudinal axis after the rod assembly has been connected to the first and second bone segments so that the first and second bone segments are brought into contact with and press against one another.

Abstract: The present invention provides a method and apparatus for achieving the fixation of a bone having a medullary canal, and in particular permits the secure and highly repeatable location of the distal locking screws used in intramdedullary nailing of long bone fractures. In accordance with a preferred embodiment of a method of the invention the distal end of an intramedullary nail is locked to the distal portion of a bone by inserting a guide wire into the medullary canal of the bone, drilling a pilot hole through the near cortex of the bone, and using a suitable locator tool that has an arrangement for grabbing the guide wire. The locator tool also has an arrangement for engaging with a suitably configured intramedullary nail. The intramedullary nail is then inserted until it engages with the locator. A distal alignment fixture engaged with the locator can then be used to determine the location of the first distal locking hole.

Abstract: A method and apparatus are provided for rapidly and precisely positioning locking screws or pins into corresponding screw holes in a orthopedic aid such as an intramedullary interlocking rod implanted in a long bone of the limb of a patient, so as to lock the rod in place in the bone. A first magnet is positioned at the location of a screw hole in the rod and an aiming device, comprising a second magnet pivotably mounted so as to be able to be brought in alignment with the first magnet, is used to locate the first magnet and hence enable a screw or pin to be guided into place through the bone into the screw hole in the rod to lock the rod in position. In one embodiment, an elongate insertion member which carries the first magnet at the distal end thereof is used to position the first magnet at the level of the hole in the rod while in a second embodiment, a solid rod is used and the magnet is removably disposed within the hole in the rod prior to implantation of the rod.

Abstract: A drill guide for drilling a transverse hole in a patient's knee to intersect a bony ligament tunnel formed in an arthroscopic surgical procedure for replacing the patient's cruciate ligament. The drill guide is U-shaped having spaced apart parallel co-planar legs extend from an arcuate base, one of which legs is solid to fit within the bony ligament tunnel and the other is holed at spaced intervals, the longitudinal axis of which holes point towards the solid leg, a select hole to receive a barrel turned therethrough that was an open longitudinal bore to guide a conventional drill turned therethrough and into the patient's knee to intersect, at a right angle, the bony ligament tunnel.

Abstract: An instrument for positioning of intra-marrow pin orifices and to guide a bit for a drilling of a bone cortical, in which an elongated member having a width and thickness suitable to resist a surgeon's pushing and a grip at one end thereof and a substantially narrowed portion at the other end for reducing as much as possible the size of an incision to be made thereby in a patient's tissues, and having a projection positioned between the ends closer to the other end and orthogonal thereto is provided with a gauge thereon, and a slidable alignment body having slidably connected with the projection for slidably connecting the prismatic body with the projection, and the slidable alignment body is fixedly coupled by a screw with the elongated member at a position thereon closer to the other end and locking the slidable alignment body to the elongated member at selected positions on the projection and the alignment body is slidably movable to different previously selected positions on the projection; and the alignm

Abstract: An orthopedic instrument serves as an adjustable guide for drills, reamers, fasteners, and other orthopedic devices which lie on a target line which extends from the lateral cortex of the femur, through an opening in the proximal end of an inserted intramedullary femoral nail, through the femoral neck, and into the femoral head. The instrument can be secured to and aligned with the inserted nail. A handle of the instrument extends downwardly from the top of the nail along a line which is substantially parallel to the target line. A guide arm is preferably slidably mounted on the handle and extends outwardly from the handle through the target line. At least one opening is formed through the guide arm coaxially with, or parallel to, the target line, for receiving a drill bit, guide tube, fastener, or similar device.

Abstract: The present invention is in a drill guide (20) that is for use with and for mounting to a "K" wire (13) that has been fitted through an anterior or posterior cruciate ligament tunnel. The drill guide (20) includes identical parallel rails (21) that are mounted to a stationary bracket (22), essentially at right angles, and are journaled to a traveling bracket (25), the traveling bracket further including set screws (28) to releasably lock it to the rails. The stationary and traveling brackets (22) and (25), respectively, are each isosceles triangular in shape, and each mounts a guide cylinder (23) and (26), respectively, at right angles through their apexes such that longitudinal openings through which guide cylinders are aligned to receive the "K" wire fitted therethrough. A trolley (30) is arranged for travel on rails (21) between the stationary and traveling brackets (22) and (25), and can be releasably locked in place.

Abstract: An intramedullary rod targeting device for guiding drilling of distal fastener screw passages in the femur of a patient during the installation in the patient's femur of an intramedullary rod is disclosed.