title: Is There an Optimal Proximal Locking Screw Length in Retrograde Intramedullary Femoral Nailing? Can We Stop Measuring for These Screws?
abstract: Insertion of locking screws through the proximal thigh while locking retrograde femoral nails is arguably more difficult and traumatic to local tissues than locking at other intramedullary nail sites. The purpose of this study was to evaluate whether a "standard" screw length for proximal interlocking of retrograde nails is possible, therefore assessing whether the act of measuring for these screws can be omitted. This article retrospective evaluates screw position and estimated proximal locking screw length in patients undergoing retrograde nailing using a large radiographically measured computed tomography cohort, with validation through a smaller clinical cohort. According to these data, it seems reasonable to skip depth gauge measurement during anteroposterior interlocking of retrograde femoral nails and insert a standard length screw based on location relative to the lesser trochanter. This should decrease the amount of local trauma to the patient at the locking screw site while increasing operating room efficiency by avoiding what can often become a difficult step during the procedure.
authors.affiliation: *Division of Orthopaedic Trauma, Harris Methodist Fort Worth Hospital, Fort Worth, TX; †Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, UMDNJ-New Jersey Medical School, Newark, NJ; ‡Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY; and §Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX.
authors.forename: Cory A
authors.initials: CA
authors.lastname: Collinge
authors.forename: John D
authors.initials: JD
authors.lastname: Koerner
authors.forename: Richard S
authors.initials: RS
authors.lastname: Yoon
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beltran
authors.forename: Frank A
authors.initials: FA
authors.lastname: Liporace
mesh_terms: D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D019544:Equipment Failure Analysis; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000379:methods*; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome