Prevention of inaccurate targeting of proximal screws during reconstruction femoral nailing

  • Ji Wan Kim
  • Derly O. Cuellar
  • Jiandong Hao
  • Benoit Herbert
  • Cyril MauffreyEmail author
Original Article • HIP - TRAUMA



The purpose of this study was to identify the underlying cause by simulating the forces involved in a controlled laboratory setting, and then to illustrate some intraoperative tips on how to detect this malalignment and suggest solutions prevent this intraoperative complication.


The Expert Asian Femoral Nail (A2FN) and Proximal Femoral Nail Antirotation (PFNA) reconstruction nail systems were evaluated to compare the characteristics of each nailing system and their reactions to soft tissue tension at the time of proximal reconstruction screw placement. Soft tissue tension was simulated by placing a fulcrum under the distal drill sleeve and exerting a load on the targeting device via the addition of weights. The occurrence and degree of guide malalignment were determined while gradually increasing the weight.


When soft tissue tension was simulated on the drill/guide sleeve of the A2FN, the drill sleeve deviated from the proximal screw hole proportionally to the weight applied and the K-wire guide passed outside of the nail at a weight of 7 kg. However, the drill sleeve of the PFNA was aligned exactly to the center of nail axis and the K-wire passed cleanly through the proximal locking hole regardless of weight applied.


Inaccurate guidance of the screw-targeting device can be caused by soft tissue tension. Thus, the authors recommend that careful attention be placed on minimizing soft tissue tension during proximal screw placement while using the targeting device of the A2FN system.


Femur Subtrochanteric fracture Reconstruction nail Targeting device Complication 


Compliance with ethical standards

This experimental study does not contain any studies with human participants performed by any of the authors. In case illustration, informed consent was obtained from the patient for the publication of this study.

Conflict of interest



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Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  • Ji Wan Kim
    • 1
  • Derly O. Cuellar
    • 2
  • Jiandong Hao
    • 3
  • Benoit Herbert
    • 3
  • Cyril Mauffrey
    • 3
    Email author
  1. 1.Department of Orthopaedic Surgery, Haeundae Paik HospitalInje University, College of MedicineBusanRepublic of Korea
  2. 2.Department of Orthopaedic SurgerySaint Louis University School of MedicineSt. LouisUSA
  3. 3.Department of Orthopaedics, Denver Health Medical CenterUniversity of Colorado, School of MedicineDenverUSA

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