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Implant insertion
The technique for insertion of the implant depends largely upon the system being used. In general, the final bone preparation site diameter is slightly smaller than the implant. The size of the site can be adjusted according to bone quality or density. In poor quality bone the site can be made relatively smaller to produce compression of the surrounding bone on implant insertion which will improve the initial stability. In dense bone the site has to more closely match the size of the implant. In bone with relatively poor medullary quality, where initial stability may be difficult to achieve, it is often advisable to secure the implant at each end in cortical bone (bicortical stabilisation) providing anatomical structures, length of implants and ability to provide adequate cooling allow this.
Circulation: If central pulses (femoral in infants and carotid in children) are not palpable, begin chest compression without losing any time. In young infants, encircle
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