Identification of the Optimal Intercondylar Starting Point for Retrograde Femoral Nailing: An Anatomic Study
- 1 October 2003
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal Of Trauma-Injury Infection and Critical Care
- Vol. 55 (4), 692-695
- https://doi.org/10.1097/01.ta.0000088857.47194.7e
Abstract
Background Retrograde nailing of femoral shaft fractures is an effective and increasingly more popular method of fracture fixation. However, concern remains regarding the effect of the intercondylar entry-portal location on knee function. Methods The optimal entry-portal location was identified in cadaver femurs. Approximating the clinical intraoperative situation, a threaded guidewire was inserted into each of 26 distal femur specimens and positioned in the center of the femoral shaft as determined by anteroposterior and lateral fluoroscopic imaging. Each guidewire was then overdrilled with a 12-mm cannulated drill bit. All entry-portal locations were recorded relative to the posterior cruciate ligament attachment and the intercondylar groove and mapped relative to the known patellofemoral contact area. Results The starting holes averaged 6.21 mm anterior to the posterior cruciate ligament attachment and 2.67 mm medial to the intercondylar groove. Overall, 100% of starting portals were located in safe areas relative to the patellofemoral contact area. Conclusion In the vast majority of femurs, the optimal entry portal for retrograde femoral nailing (in line with the long axis of the femur) is located in the expected safe position, anterior to the posterior cruciate ligament insertion and slightly medial to center of the intercondylar groove. However, because of anatomic variability, the ideal starting position occasionally may be located in a patellofemoral contact area. Potential compromise of the patellofemoral contact area by the retrograde nail entry portal can and should be recognized before nailing, allowing the surgeon the option of altering the surgical technique.Keywords
This publication has 10 references indexed in Scilit:
- Retrograde Nailing of the Femoral ShaftJournal of the American Academy of Orthopaedic Surgeons, 1999
- Effects of Retrograde Femoral Intramedullary Nailing on the Patellofemoral ArticulationJournal of Orthopaedic Trauma, 1999
- Retrograde Intramedullary Nailing of Femoral Diaphyseal FracturesJournal of Orthopaedic Trauma, 1998
- Unreamed Retrograde Intramedullary Nailing of Fractures of the Femoral ShaftJournal of Orthopaedic Trauma, 1998
- Retrograde Nailing of the Femoral DiaphysisTechniques in Orthopaedics, 1998
- Retrograde Nailing of the Femur Using an Intercondylar ApproachPublished by Ovid Technologies (Wolters Kluwer Health) ,1996
- Retrograde intramedullary nailing, without reaming, of fractures of the femoral shaft in multiply injured patients.The Journal of Bone & Joint Surgery, 1995
- Retrograde Reamed Femoral NailingJournal of Orthopaedic Trauma, 1993
- Retrograde Femoral NailingJournal of Orthopaedic Trauma, 1993
- A New Patella ProsthesisPublished by Ovid Technologies (Wolters Kluwer Health) ,1975