Correct anatomical location of entry point for antegrade femoral nailing S.P. Kale a , N. Patil a , S. Pilankar a , A.R. Karkhanis a , V. Bagaria b, * a R.N. Cooper Hospital, Ville Parle (W), Mumbai 400056, India b CIIMS Hospital, Bajaj Nagar, Nagpur, India Accepted 1 June 2006 Introduction Closed intramedullary nailing is a well-accepted method of treating femoral shaft fractures. 2,7,12,35 The intramedullary interlocking technique is consid- ered superior to plating andexternal fixation from the biomechanical point of view. Although the success of intramedullary nailing is determined by various fac- tors such as the form and stability of the implant and good reduction of the fracture fragments, the choice of entry point is of utmost importance and demands detailed anatomical knowledge. The issue of the correct entry point remains a matter of controversy, there are varied opinions and the literature is con- fusing. 17 Some authors prefer an entry point at the tip of greater trochanter, 19,26 whereas others prefer the fossa piriformis. 6,20,35 The main objective in defining the appropriate entry point is to permit introduction of the nail without tension, with minimal prereaming of the medullary cavity and with anatomical align- ment of the bone fragments. This study aimed to review by means of question- naires the opinions of orthopaedic surgeons as to the correct entry point for ante grade femoral nailing. Materials and methods At a prominent orthopaedic meeting, question- naires on the entry point for antegrade femoral Injury, Int. J. Care Injured (2006) 37, 990—993 www.elsevier.com/locate/injury KEYWORDS Femoral nailing; Entry point; Piriformis fossa; Trochanteric fossa Summary Closed intramedullary nailing is a well-accepted method of treatment for femoral shaft fractures. The issue of the correct entry point for antegrade nailing remains a matter of controversy, and the literature is confusing. We reviewed the opinions of 100 orthopaedic surgeons by means of questionnaires. Only four surgeons were able to identify and label their respective entry points for femoral nailing correctly, possibly because of incorrect illustration in publications or errors in terminology. Although the piriformis fossa appears to be the ideal entry point, the importance of exact localisation in the sagittal plane, centered over the axis of medullary canal, cannot be overlooked. # 2006 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +91 9323 951 631; fax: +91 712 2236 416. E-mail address: bagariavaibhav@gmail.com (V. Bagaria). 0020–1383/$ — see front matter # 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2006.06.003