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Predicting the optimal entry point for femoral antegrade nailing using a new measurement approach

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

To establish a new reliable approach for measuring proximal femoral anatomical parameters and determining the optimal entry point of the antegrade intramedullary (IM) nailing.

Methods

A new method for measuring the proximal femoral anatomy and locating the optimal entry point for the antegrade nailing was developed using Mimics and 3-Matic softwares (Materialise, Haasrode, Belgium). After verifying the reliability of the measurement method using 15 pairs of the femoral models by the intraclass correlation coefficient, the anatomical parameters of 200 Chinese femurs were measured, and statistical analyses were performed to compare the proximal femoral anatomical parameters between different genders or lateralities and determine the most relevant factors of the optimal entry point.

Results

Reliability study showed that both intraobserver reliability and interobserver reliability of the current measurement approach were excellent. After independent samples \(T\)-test, the proximal femoral anatomical parameters were shown significant difference between genders. Stepwise regression statistical analyses showed that the most relevant factors of the distances between the optimal entry point and the femoral head centre, the femoral neck axis and the tip of the greater trochanter were the 3D femoral neck-shaft angle (Pearson’s \(r = -0.621\); the model’s \(P < 0.001,\, R^{2}= 0.437\)), the femoral radius (Pearson’s \(r = -0.413\); the model’s \(P < 0.001,\, R^{2}= 0.254\)) and the femoral length (Pearson’s r = 0.316; the model’s \(P < 0.001,\, R^{2} = 0.154\)), respectively.

Conclusions

The current study provided a new and reliable measurement approach to evaluating the anatomical morphology of the proximal femur and revealed the most influential factors on the locations of the simulated optimal entry point for the proximal femoral antegrade IM nailing. Furthermore, this study was useful for establishing methodological basis for future researches and developments of the custom-made IM nailing and affiliated surgical instruments.

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Acknowledgments

Thanks to Dr. Song Zhang, Dr. Lin Han, and Dr. Xiaofeng Yu, who participated to reconstruct the 3D femoral modal. This work was partially supported by China Postdoctoral Science Foundation (No. 2013M542448).

Conflict of interest

The authors declare that they have no conflict of interest.

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Author notes

    Authors and Affiliations

    1. Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China

      Jing-xin Zhao, Xiu-yun Su, Zhe Zhao, Li-cheng Zhang, Zhi Mao, Hao Zhang, Li-hai Zhang & Pei-fu Tang

    2. Department of Orthopaedics, Affiliated Hospital of the Academy of Military Medical Sciences, No.8 Dongdajie Road, Beijing, 100071, People’s Republic of China

      Xiu-yun Su

    3. Department of Orthopaedics, Beijing Tsinghua Chang Gung Hospital, No.1 Block Tiantongyuan North, Beijing, 102218, People’s Republic of China

      Zhe Zhao

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    1. Jing-xin Zhao
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    Corresponding author

    Correspondence to Pei-fu Tang.

    Additional information

    Jing-xin Zhao, Xiu-yun Su and Zhe Zhao have contributed equally to this work.

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    Zhao, Jx., Su, Xy., Zhao, Z. et al. Predicting the optimal entry point for femoral antegrade nailing using a new measurement approach. Int J CARS 10, 1557–1565 (2015). https://doi.org/10.1007/s11548-015-1182-5

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    • DOI: https://doi.org/10.1007/s11548-015-1182-5

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