Optional entry point for retrograde femoral nailing: an anatomical study using the reverse engineering method.

Objective: To investigate the optimal entry point for retrograde femoral nailing using medical imaging and reverse engineering technologies.

Material And Method: One hundred and eight adult cadaveric femurs were scanned using a computed tomography (CT) scanner. To obtain three-dimensional models, medical imaging and reverse engineering technologies were used. The insertion assessment was performed using computer aided design (CAD) software. The curve representing the mid-line in the intramedullary canal in the mid-shaft region was approximated using regression analysis. The curve was extended tangentially toward the femoral condyle, where the intersection between the curve and the condylar surface is the insertion site. The location of the insertion site was determined using the center of the anterior most of the intercodylar notch as a reference point. The measured distances were presented in medial-lateral and anterior-posterior perspectives from the reference point.

Results: Average insertion site for Thai population was 0.56 mm lateral to and 12.67 mm medial to the anterior most of the intercondylar notch. The distance measured from intercondylar notch to the insertion site in the anterior-posterior direction was not significantly different between males and females; however a significant difference in the insertion site was found in medial-lateral directions.

Conclusion: The insertion site can be clinically approximated lying on the anterior-posterior axis, since the distance from the anterior-posterior axis to the insertion site is relatively small. The insertion site for the Thai population was found to be 12 mm anterior to the center of the anterior most of the intercondylar notch.