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Posterior perforation of the distal femur
7%
176/2690
Varus malreduction
2%
57/2690
Comminution of the fracture site
1%
32/2690
Iatrogenic femoral neck fracture
62/2690
Anterior perforation of the distal femur
88%
2360/2690
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According to the study by Egol et al, the average femoral anterior radius of curvature was 120 cm (+/- 36 cm), and currently available femoral nails have a greater radius of curvature (i.e. more straight). This mismatch has been shown to lead to an increased risk of perforation of the anterior distal femur as the nail is impacted into the canal. The referenced study by Tencer et al noted an increased risk of iatrogenic femoral fracture with anterior starting point >6mm from the anatomic axis. They recommend starting in line with the femoral axis, or just a few millimeters anterior in order to minimize this risk. Illustration A depicts anterior femoral cortex penetration secondary to nail/femur radius of curvature mismatch.
4.2
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