Medullary Cavity's Topometry on Proximal Femur for Intramedullary Nailing

İsmailoğlu P. , Soyluoğlu A. İ. , Bayramoğlu A.

1st International Mediterranean Anatomy Congress, Konya, Türkiye, 6 - 09 Eylül 2018, cilt.2, no.12, ss.174

  • Cilt numarası: 2
  • Doi Numarası: 10.2399/ana.18.s2sv
  • Basıldığı Şehir: Konya
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.174


Medullary cavity’s topometry on proximal femur for

intramedullary nailing

İsmailo¤lu P1, Soyluoğlu Aİ2, Bayramoğlu A1, Özsoy H3

1Department of Anatomy, Ac›badem Mehmet Ali Ayd›nlar University,

Istanbul, Turkey; 2Department of Anatomy, Cerrahpafla Faculty of

Medicine, Istanbul University-Cerrahpafla, Istanbul, Turkey; 3Orthopedics

and Traumatology, Memorial Ankara Hospital, Ankara, Turkey

Objective: Intramedullary femoral nailing is a widely used technique

in proximal and mid-shaft femoral fractures. In spite of the

importance of correct entry point, the published data is still

unclear about anatomical landmarks. We sought to determine

the ideal entry point for antegrade femoral nailing.

Metod: Sectra IDS7 multi-touch screen visualization table, a

commercially available 3D reconstructor of CT&MR images, was

used to reconstruct CT images in 3D. 51 low abdomen and pelvis

CT images were investigated. The paired femors from 51 CT

images were used. So, right and left 102 femurs’ proximal regions

were visualized. The borders of femoral medullary cavity were

drawn on the proximal femur picture. The center of medullary

cavity were shown. The proximal femur was divided into 16

regions on the upper view. Then the center and trochanteric fossa

was identifid according to the regions. The greater trochanteric

tip was also evaluated if it covered the nail insertion area.

Results: The projection of medullary cavity’s center was

31.4% more anteromedial according to trochanteric fossa for

right side. For left side it was 39.2% more anteromedial to

trochanteric fossa. There weren’t any differences between genders

about trochanteric fossa or the projection of center. The

center was covered in just one femur by the trochanteric tip for

both sides. The covering ratio for right side was 66.7% by the

tip of the greater trochanter if trochanteric fossa entry point

was preferred. The similar ratio for the left side was 88.2%.

Conclusion: The best insertion point for antegrade femoral

nailing is anteromedial side of trochanteric fossa. The greater

trochanteric tip doesn’t cover the projection of medullary cavity’s

center. Therefore, the projection of medullary cavity’s

center is a safe region. By using 3D imaging techniques before

surgery is the best way to find ideal entry point localisation.

Keywords: intramedullar, femoral fractures, computed

tomography, orthopedic surgery