Potential of increased risk of neurovascular injury using proximal interlocking screws of retrograde femoral nails in patients with acetabular fractures

Use of novel and inexpensive radiolucent soft tissue protector for insertion of proximal locking screws in femoral retrograde intramedullary nailing

We use a straightforward technique for insertion of proximal interlocking screw fixation during retrograde intramedullary nailing of the femur utilizing a common 3 cc syringe as a radiolucent soft tissue protector. Following insertion of the implant and distal interlock insertion, the distal Luer-Lok tip of a 3 cc syringe is cut off to create a hollow tube. Once the correct location of the proximal locking holes is confirmed fluoroscopically, the syringe is inserted through the incision into the soft tissue over the long drill sleeve and trochar. The inner drill guide and trochar is then removed, leaving only the syringe. Through this syringe, the proximal interlocking hole is drilled and measured, and the screw is inserted. The syringe establishes a safe pathway for passage of instrumentation, mitigating damage to the surrounding soft tissues, and allowing for unobstructed fluoroscopic visualization throughout insertion of the locking screws. This technique is safe, inexpensive and reproducible; utilizing common equipment available in most operative settings.

Is There an Optimal Proximal Locking Screw Length in Retrograde Intramedullary Femoral Nailing? Can We Stop Measuring for These Screws?

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.

An alternative direction for proximal locking in retrograde femoral nails

Lateral-to-medial proximal interlocking screw insertion for retrograde femoral nails avoids potential neurovascular injury while maintaining stable interlocking mechanics.