“Trochanteric” Recon Nails May Need a New Name

Start just a little lateral to the canal, not always at the "tip" of the greater torch, for the best starting point, but don't forget to do your preoperative planning, as there is important variability to consider

Smart Practice: For trochanteric-start reconstruction nails, the “trochiformis” site is often a great starting point for your guidewire, but preop planning remains key.

What’s the Claim?

A study that templated starting points for three commonly used reconstruction nails (Natural Nail, Zimmer Biomet; TAN/FAN, Smith & Nephew; T2 alpha, Stryker) found that the ideal start point to avoid varus displacement of the fracture for so-called greater trochanteric entry nails is, in fact, consistently medial to the "tip" of the greater trochanter. How far medial depends on whether it’s a straight or valgus-bend nail, so preoperative planning seems important. Increasing amounts of valgus (higher neck-shaft angles) were associated with more medial entry points being more correct.

How’s It Stack Up?

The so-called “trochiformis” (a hybrid of a greater trochanteric and piriformis) entry point has been proposed before, and the current study confirms it’s a good choice for modern 5° to 6° valgus-bend nails. This choice seems likely to prevent varus malreductions. The finding that hips with more severe varus usually have more lateral (toward the trochanteric tip) start points likewise is confirmatory of some good earlier work.

What’s Our Take?