A Central Collinear Start Point for Reconstruction Nailing of Femur Fractures: A Technical Trick and Case Series

Abstract

Summary:Selecting the optimal entry point for reconstruction nailing is critical to avoid iatrogenic malalignment and optimize mechanical stability. In-line nailing is familiar to surgeons and desirable for its on-axis position. However, there are several potential drawbacks. We describe a modified entry point and present an accompanying clinical series emphasizing an entry point in line with the medullary canal and central on the femoral neck. This central collinear start point is anterior to the traditional piriformis start point and may obviate some of the potential drawbacks with traditional piriformis nailing.

Optimizing the Entry Point for Reconstruction Nailing of the Femur

“…In 2019, Berkes et al proposed a more medialized "trochiformis" entry for insertion of GT nails to prevent iatrogenic proximal femoral varus. 13 More recently, Robles et al 14 described a central collinear entry point that lies just anterior to the piriformis fossa, facilitating central placement of reconstruction screws in the femoral neck. These entry points prompt the question: Are valgus-entry and straight nails approaching a universal entry point?…”