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. 2023 Sep 15;31(18):e721-e726.
doi: 10.5435/JAAOS-D-22-00778. Epub 2023 May 18.

Optimizing the Entry Point for Reconstruction Nailing of the Femur

Abrianna S Robles  1 , Jawad J Najdawi, Juntian Wang, Zachary A Rockov, Harin B Parikh, Milton T M Little, Geoffrey S Marecek
Affiliations

Optimizing the Entry Point for Reconstruction Nailing of the Femur

Abrianna S Robles et al. J Am Acad Orthop Surg. .

Abstract

Introduction: Varus after antegrade medullary nailing of the proximal femur is associated with worse outcomes. Anecdotally, a more medialized "trochiformis" entry is beneficial to avoid varus with valgus-bend (greater trochanteric entry) femoral nails. However, the optimal entry point remains unknown. The purpose of this study was to define the optimal entry point for reconstruction nailing.

Methods: Using standing alignment radiographs from 51 patients, we templated the ideal entry point for straight and valgus-bend nails from three major manufacturers using TraumaCad software. We measured the distance from the tip of the trochanter to the ideal entry site for each nail. We compared piriformis (PF) with trochanteric (GT) entry for each company and across manufacturers.

Results: The mean greater trochanter offset from the femoral axis was 15.2 mm. The mean PF entry was 5.9 to 6.7 mm medial to the mean GT entry for each company's nail and was statistically distinct. No differences were observed in GT and PF entry points across manufacturers. Only 2 of 153 ideal GT entry points were lateral to the tip of the trochanter. An increased neck-shaft angle (NSA) and increased GT offset were correlated with a more medial ideal entry point.

Discussion: The ideal entry point for GT nails is similar across manufacturers and is medial to the tip of the greater trochanter; however, PF and GT entry sites remain distinct. During preoperative planning and when executing femoral nailing intraoperatively, it may also be important to consider the NSA and GT offset of a patient before committing to a certain entry point.

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References

    1. Russell TA: Intramedullary nailing: Evolutions of femoral intramedullary nailing: First to fourth generations. J Orthop Trauma 2011;25:S135-S138.
    1. Ricci WM, Gallagher B, Haidukewych GJ: Intramedullary nailing of femoral shaft fractures: Current concepts. J Am Acad Orthopae Surg 2009;17:296-305.
    1. Starr AJ, Hay MT, Reinert CM, Borer DS, Christensen KC: Cephalomedullary nails in the treatment of high-energy proximal femur fractures in young patients: a prospective, randomized comparison of trochanteric versus piriformis fossa entry porta. J Orthop Trauma 2006;20:240-246.
    1. Stannard JP, Bankston LS, Jennings JK, et al.: Piriformis vs Trochanteric Antegrade Nailing of Femoral Fractures: A Prospective Randomized, 2009.study. American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting; 25-28 Feb.
    1. Gausepohl T, Pennig D, Koebke J, Harnoss S: Antegrade femoral nailing: An anatomical determination of the correct entry point. Injury 2002;33:701-705.