Journal List > J Korean Fract Soc > v.30(4) > 1129884

Jeong and Jung: The Determination of Optimal Entry Point for Proximal Femoral Nail Antirotation-II by Fluoroscopic Simulation: A Cadaveric Study

Abstract

Purpose

This study seeks to determine the anatomically optimal entry point of proximal femoral nail antirotation-II (PFNA-II®) according to geographic features of Korean cadaveric femoral trochanters for successful reduction of osteoporotic proximal femoral fractures.

Materials and Methods

Forty-three adult cadaveric femurs without previous fractures or surgeries were included. Anteroposterior (AP) and lateral images of all femurs and PFNA-II® were taken with an image intensifier. Using the image synthesis process via the image editing program (Adobe Photoshop CS6), the optimal entry point was verified and compared with the tip of the greater trochanter (GT) and the cervicotro-chanteric junction on AP images, as well as the width of the trochanter and the neck on lateral images.

Results

The optimal entry point of PFNA-II® was an average distance of 9.1 mm (range, 7–15 mm) medially from the tip of GT on AP images. The center of the nail was located at an average of 30% (range, 21%–44%) area from the posterior margin of the middle neck, which is an average area of 38% (range, 26%–48%) from the posterior cortex of the trochanter on lateral images. Furthermore, the ideal entry point was at the extended line of the cervico-trochanteric junction.

Conclusion

The optimal entry point, which was found to be medial to the tip of the GT and posterior to the center of the middle femoral neck and the trochanter, was at on the extended line of the cervicotrochanteric junction.

Figures and Tables

Fig. 1

A cadaveric adult femur that is marked with lead wires. To verify clearly through an image intensifier, the femur was marked with easily flexible lead wires on (1) the circumference of the femoral neck, (2) the cervico-trochanteric junction, and (3) the most protruded portions of anterior and posterior surfaces of the trochanter passing the tip of the greater trochanter.

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Fig. 2

Image synthesis process on the anteroposterior (AP) plane with the image editing program. (A) An AP image of the femur, (B) an AP image of proximal femoral nail antirotation-II (PFNA-II®), (C) synthesized images of the femur and the cephalomedullary nail on the ideal position, (D) drew a line bisecting the proximal part of PFNA-II®, (E) checked the ideal entry point (*) of the nail on the femur, and removed the image of the nail, (F) measured the distance (d) between the ideal entry point (*) and the tip of the greater trochanter (**).

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Fig. 3

Image synthesis process on the lateral plane with an image editing program. (A) A lateral image of the femur, (B) synthesized images of the femur and cephalomedullary nail on the ideal position, and drew a line bisecting the proximal part of proximal femoral nail antirotation-II (PFNA-II®), (C) measured the width of the femoral neck and the distance between a posterior cortex of the femoral neck and the center of nail, (D) measured the width of the trochanter and the distance between a posterior cortex of the trochanter and the center of nail.

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Fig. 4

Ideal entry point (*) was at the extended line of the cervicotrochanteric junction.

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Notes

Financial support None.

Conflict of interests None.

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TOOLS
ORCID iDs

Jin-Hoon Jeong
https://orcid.org/0000-0003-2731-1581

Gu-Hee Jung
https://orcid.org/0000-0002-9751-4678

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