Proximal Femur Nail Start Points.pptx

Starting points for IMN

1. NAILING PROXIMAL FEMUR FRACTURES: HOW TO CHOOSE A START POINT METZ, Weird first name , MD

2. PIRIFORMIS START Location “on axis” start On AP view: just medial to the prominence of the trochanter within the fossa On lateral view: relatively posterior to the femoral neck, in line with the femoral canal Advantages Collinear trajectory with the femoral shaft Disadvantages Can be technically challenging especially in obese Trochanteric overhang or bulky short external rotators Vascular risk to femoral head – branches of medial femoral circumflex

3. TROCHANTERIC START Location Tip of the greater trochanter Advantages Decreased operative time and fluoroscopy? Controversial May be somewhat easier in obese/heavy patients Less dangerous to the abductor complex and femoral head blood supply Disadvantages Varus malignment if not using lateral proximal bend nails Lateral wall blowout

4. CHOOSING THE START POINT Fracture pattern Where do fracture lines exit and would they interfere when reaming or inserting nail CT can be helpful Patient morphology Obese Trochanteric overhang Other injuries (such as spine fractures) Operating table Fracture table Supine or “floppy” lateral on radiolucent table Lateral