title: Retrograde femoral nailing: computed tomography angiogram demonstrates no relative safe zone for prevention of small diameter arterial vascular injury during proximal anteroposterior interlocking.
abstract: BACKGROUND
  Reported iatrogenic injury to the proximal femoral vascular structures is rare after retrograde femoral nailing. Previous cadaveric dissections have recommended placement of proximal interlocking screws above the level of the lesser trochanter.
  
  
  METHODS
  This study is designed to define the arterial vascular anatomy anterior to the proximal medullary canal of the femur, which could be damaged with the placement of anteroposterior (AP) proximal interlocking screws.
  
  
  RESULTS
  Computed tomography angiograms of the structures anterior to the proximal femur demonstrate the presence of arterial branches >2 mm diameter in 100% of study patients at or above the level of the lesser trochanter.
  
  
  CONCLUSIONS
  No true safe zone corridor exists anteriorly for placement of AP interlocking screws in this region. Surgical technique modifications are suggested to minimize the potential risks of iatrogenic arterial injury during retrograde femoral nail AP proximal interlocking.
authors.affiliation: Department of Orthopaedics, West Virginia University, Morgantown, West Virginia 26506-9196, USA. fshuler@hsc.wvu.edu
authors.forename: Franklin D
authors.initials: FD
authors.lastname: Shuler
authors.forename: Matthew
authors.initials: M
authors.lastname: Busam
authors.forename: Claire F
authors.initials: CF
authors.lastname: Beimesch
authors.forename: John J
authors.initials: JJ
authors.lastname: Block
mesh_terms: D000792:Angiography / Q000379:methods*; D001858:Bone Nails; D001863:Bone Screws; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006801:Humans; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000517:prevention & control*