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We have reviewed our experience of four iatrogenic femoral neck fractures in 315 consecutive closed intramedullary nailings with the AO/ASIF universal femoral nail. The average neck-shaft angle in the bones that fractured was 139.3 degrees +/- 1.2 degrees SD (136 to 141); in the whole series the average neck-shaft angle was 125.3 degrees +/- 8.6 degrees and only 11 had angles of more than 135 degrees. The upper ends of the nails in the four which fractured were 17 mm, 5 mm, 3 mm, and 1 mm below the tip of the greater trochanter. In the seven patients with neck-shaft angles greater than 135 degrees but with no fracture, none of the nails had been inserted beyond the tip of the greater trochanter. We nailed six cadaver femora to simulate the forces produced by intramedullary nailing. Despite deep insertion, only one of the six sustained a neck fracture. This specimen had a radiographic neck-shaft angle of 140 degrees against an average of 127.3 degrees +/- 4.0 degrees for the other five. We believe that the medial prong of the AO insertion jig, with its medial overhang of 2 to 3 mm, may impinge on the superior aspect of a valgus femoral neck during final impaction, causing a neck fracture. This may be avoided by leaving the end of the nail above the tip of the trochanter in such cases.
P T Simonian, and
J R Chapman, and
H S Selznick, and
S K Benirschke, and
B F Claudi, and
M F Swiontkowski
October 2009,
European journal of trauma and emergency surgery : official publication of the European Trauma Society,
P T Simonian, and
J R Chapman, and
H S Selznick, and
S K Benirschke, and
B F Claudi, and
M F Swiontkowski
April 1972,
The Journal of bone and joint surgery. American volume,
P T Simonian, and
J R Chapman, and
H S Selznick, and
S K Benirschke, and
B F Claudi, and
M F Swiontkowski
April 1986,
The Journal of the Arkansas Medical Society,
P T Simonian, and
J R Chapman, and
H S Selznick, and
S K Benirschke, and
B F Claudi, and
M F Swiontkowski
March 1982,
The Journal of bone and joint surgery. American volume,
P T Simonian, and
J R Chapman, and
H S Selznick, and
S K Benirschke, and
B F Claudi, and
M F Swiontkowski
March 1979,
The Journal of bone and joint surgery. American volume,
P T Simonian, and
J R Chapman, and
H S Selznick, and
S K Benirschke, and
B F Claudi, and
M F Swiontkowski
October 1994,
Injury,
P T Simonian, and
J R Chapman, and
H S Selznick, and
S K Benirschke, and
B F Claudi, and
M F Swiontkowski
January 1975,
Clinical orthopaedics and related research,
P T Simonian, and
J R Chapman, and
H S Selznick, and
S K Benirschke, and
B F Claudi, and
M F Swiontkowski
January 1982,
The Journal of bone and joint surgery. British volume,
P T Simonian, and
J R Chapman, and
H S Selznick, and
S K Benirschke, and
B F Claudi, and
M F Swiontkowski
August 1996,
Journal of the Royal College of Surgeons of Edinburgh,
P T Simonian, and
J R Chapman, and
H S Selznick, and
S K Benirschke, and
B F Claudi, and
M F Swiontkowski
January 1986,
Journal of pediatric orthopedics,
