Piriform fossa, trochanteric fossa and greater trochanteric tip have each been described as entry points for antegrade femoral nailing. However, the terminology used for these entry points is confusing. The accuracy of the entry point nomenclature in published text and illustrations was recorded in this review study. The trochanteric fossa, a deep depression at the base of the femoral neck is indicated as 'piriform fossa' in the vast majority of the publications. Other publications indicate the insertion site of the tendon of the piriformis muscle on the greater trochanteric tip as 'piriform fossa'. As a result of recurrent terminology error and consistent reproductions of it, the recommended entry point in literature is confusing and seems to need standardisation. The piriform fossa does not appear to exist in the femoral region. The trochanteric fossa is the standard entry point which most surgeons recommend for facilitating a standard straight intramedullary nail, as is in line with the medullary canal. The greater trochanteric tip is the lateral entry point for intramedullary nails with a proximal lateral bend.
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http://dx.doi.org/10.1016/j.injury.2012.08.049 | DOI Listing |
J Orthop
June 2025
The Affiliated Hospital of Qingdao University, Qingdao Cancer Institute, Qingdao University, Qingdao, 266071, China.
Study Objective: This study aims to validate the application effects of a novel theoretical model of dynamic parallel traction in the treatment of femoral neck fractures through three-dimensional finite element analysis. By simulating the femoral neck fracture model, we explore the promotional effect of dynamic parallel traction on fracture healing.
Method: A digital 3D femur model was constructed using high-resolution computed tomography data of the lower limbs of a 70-year-old elderly subject.
Vet Comp Orthop Traumatol
August 2024
Campinas, São Paulo, Brazil.
Objective: To evaluate the in vitro mechanical properties of basilar fractures of the femoral neck stabilized with two or three titanium-cannulated screws in dogs.
Study Design: Ex vivo study.
Sample Population: Cadaveric canine femur ( = 21).
Eur J Orthop Surg Traumatol
August 2024
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Al Mokhayyam Al Dayem Street, Nasr City, Cairo, 11675, Egypt.
Cephalomedullary nailing for unstable proximal femoral fractures is widely utilized, especially for geriatric osteoporotic fractures. There are two starting points for entry, namely trochanteric tip entry and pyriformis fossa entry, both have advantages and disadvantages, the tip of the greater trochanter seems that it is not the ideal starting point for trochanteric entry nails, the study presents the foothill entry point as a reproducible, technically feasible entry point to overcome the shortcoming of both standard starting points, and it could be easy executed with clear intraoperative fluoroscopic landmarks and lead to appropriate nail position without intraoperative complications.
View Article and Find Full Text PDFInjury
August 2024
Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA; Orthopaedic Biomechanics Laboratory, Cedars Sinai Medical Center, Los Angeles, CA, USA. Electronic address:
Introduction: Reconstruction nails are commonly used to treat proximal femur fractures, with cephalic screw placement for femoral neck "prophylaxis" becoming standard practice. These implants are traditionally introduced through piriformis fossa (PF) or greater trochanter (GT) entry portals. A third "central collinear" (CC) portal has been proposed that allows entry along the femoral anatomic axis and central placement of cephalic screws.
View Article and Find Full Text PDFArch Orthop Trauma Surg
June 2024
Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL, USA.
Introduction: Entry point selection, a crucial aspect of femoral antegrade nailing, can impact nail fit and consequently fracture reduction. In adults, the standard entry portals used are the piriformis fossa and the tip of the greater trochanter. Previous systematic reviews comparing the two techniques have not been limited to Randomized Controlled Trials (RCTs) and have not consistently included the same available RCTs.
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