Malpositioning of the trochanteric entry point
during the introduction of an intramedullary nail may cause iatrogenic
fracture or malreduction. Although the optimal point of insertion
in the coronal plane has been well described, positioning in the
sagittal plane is poorly defined. The paired femora from 374 cadavers were placed both in the anatomical
position and in internal rotation to neutralise femoral anteversion.
A marker was placed at the apparent apex of the greater trochanter,
and the lateral and anterior offsets from the axis of the femoral
shaft were measured on anteroposterior and lateral photographs. Greater
trochanteric morphology and trochanteric overhang were graded. The mean anterior offset of the apex of the trochanter relative
to the axis of the femoral shaft was 5.1 mm ( Placement of the entry position at the apex of the greater trochanter
in the anteroposterior view does not reliably centre an intramedullary
nail in the sagittal plane. Based on our findings, the site of insertion
should be about 5 mm posterior to the apex of the trochanter to
allow for its anterior offset. Cite this article:
Primary total hip replacements are routine procedures with good outcomes. To ensure uniformly good results it is important that a thorough preoperative assessment of the patient is made. The prosthesis best suited to the patient and the pathology must be carefully selected and the optimal surgical technique must take into account patient, pathology and prosthesis parameters. We discuss patients’ problems such as morbid obesity, the different arthritides and neuromotor abnormalities. Acetabular problems, including dysplastic acetabula and acetabula protrusio, are dealt with in detail. We examine post-traumatic hip pathologies, including retained fracture implants, nonunions and ankyloses. On the femoral side, dysplastic
