Retrograde Femoral Nailing: Computed Tomography Angiogram Demonstrates No Relative Safe Zone for Prevention of Small Diameter Arterial Vascular Injury During Proximal Anteroposterior Interlocking

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Abstract
Reported iatrogenic injury to the proximal femoral vascular structures is rare after retrograde femoral nailing. Previous cadaveric dissections have recommended placement of proximal interlocking screws above the level of the lesser trochanter. This study is designed to define the arterial vascular anatomy anterior to the proximal medullary canal of the femur, which could be damaged with the placement of anteroposterior (AP) proximal interlocking screws. Computed tomography angiograms of the structures anterior to the proximal femur demonstrate the presence of arterial branches >2 mm diameter in 100% of study patients at or above the level of the lesser trochanter. No true safe zone corridor exists anteriorly for placement of AP interlocking screws in this region. Surgical technique modifications are suggested to minimize the potential risks of iatrogenic arterial injury during retrograde femoral nail AP proximal interlocking.

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