Lateral femoral line: a technique for easy insertion of newer femoral reconstruction nails.

The newer second generation reconstruction nails, such as the proximal femoral nail (Synthes-Stratec, Oberdorf, Switzerland), Russell-Taylor Delta nail (Smith & Nephew Inc, Memphis, Tenn) and gamma nail (Stryker Corp, Kalamazoo, Mich), produce satisfactory results clinically and biomechanically in the treatment of unstable proximal femoral fractures.1-4 The key to smooth progression of the surgery is in making the appropriate skin incision and femoral entry portal. The entry portal for these nails is at or slightly lateral to the tip of the greater trochanter. An inappropriate incision makes it difficult to identify the entry portal site. This could potentially increase the surgical time, as the image intensifier would have to be put through a series of maneuvers from anteroposterior (AP) to lateral views and vice versa to ensure the femoral entry portal is at the correct site. An inappropriate entry point in the proximal femur could also damage the hip abductor mechanism.5 As the femur has an anterior bow, the incision for the femoral entry portal should be sited in line with the proximal femoral shaft inclination, which takes the entry point into the posterior half of the greater trochanter.6 Experienced trauma surgeons are able to “eyeball” the correct femoral entry portal using the appropriate skin From Arrowe Park Hospital, Wirral, Merseyside, United Kingdom. Reprint requests: G. Kumar, FRCS, Flat 89, Block C, Arrowe Park Hospital, Wirral CH49 5PE. The lateral femoral line technique identifies the correct femoral entry portal for the insertion of second-generation femoral reconstruction nails. Lateral Femoral Line: A Technique for Easy Insertion of Newer Femoral Reconstruction Nails