Abstract
Operative problems in the application of femoral locking nails are frequently related
to an unfavourable entry point at the greater trochanter. Especially in more distally
located fractures the nail is forced to follow the cortex abutted medullary canal.
A wrong defined entry point either in the medio-lateral or dorso-ventral direction
inevitably leads to tension between nail and femur. Forceful insertion in this situation
may cause disastrous iatrogenic comminution at the fracture side or additional fractures
at the proximal femur. To avoid tension between nail and femur the best suited entry
point must be defined according to the natural medullary cavity.
In 16 human cadaver femora, the natural medullary cavity was opened and after cleaning
filled with a radio-opaque substance (barium sulphate). Twelve radiographs where taken
from each bone starting with the anterior–posterior view and then turning the bone
axially in steps of 15°. From these radiographs, the ideal entry point at the greater
trochanter was calculated.
In 88% of the specimen the ideal entry point for a straight nail was found constantly
at the medial border of the greater trochanter overlaying the tendinous insertion
of the piriformis muscle. The axis of the medullary cavity was in average 2.1 cm anterior to the dorsal border of the greater trochanter.
In a second step the ideal entry point for bend nails was calculated. According to
this calculation a bend nail with a radius of 100 cm needs an entry point 0.7 mm anterior to the dorsal edge of the greater trochanter. Overlaying the hook like
shape of the posterior part of the trochanter.
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Article info
Publication history
Accepted:
April 25,
2002
Identification
Copyright
© 2002 Elsevier Science Ltd. Published by Elsevier Inc. All rights reserved.
