This anatomical study measured the anterior bow of 948 femurs from museum skeletal collections and compared those measurements to the curvature specifications of 8 current antegrade intramedullary nails. The question: are modern IM nails actually shaped to match the femur they're inserted into?
When you're nailing an intertrochanteric fracture and the anterior bow is intact, the nail has no fracture gap to accommodate its straighter geometry — that's when anterior cortical penetration happens distally.
On the lateral intraoperative fluoroscopic view, watch for the nail tip crowding the anterior cortex; if it's happening, consider a longer nail to distribute the mismatch or flag the case for implant selection review.
This anatomical study measured the anterior bow of 948 femurs from museum skeletal collections and compared those measurements to the curvature specifications of 8 current antegrade intramedullary nails. The question: are modern IM nails actually shaped to match the femur they're inserted into?
When you're nailing an intertrochanteric fracture and the anterior bow is intact, the nail has no fracture gap to accommodate its straighter geometry — that's when anterior cortical penetration happens distally.
On the lateral intraoperative fluoroscopic view, watch for the nail tip crowding the anterior cortex; if it's happening, consider a longer nail to distribute the mismatch or flag the case for implant selection review.