Closed intramedullary nailing of diaphyseal fractures of the femur. Problems related to anatomical variations of the greater trochanter.

An examination of the radiographs of 100 normal femurs revealed an anatomical variation consisting of lateralization of the trochanteric mass in relation to the femoral diaphysis. This involves disalignment of the apex of the greater trochanter in relation to the medullary canal, with consequent complications during closed intramedullary nailing such as varus of the fracture segments, valgus of the nail, fracture of the medial cortex. Since becoming aware of this anatomical variation and its possible consequences, the authors now carry out routine preoperative A.P. radiographs of the contralateral femur and if lateralization of the trochanteric mass is observed, the nail is not inserted at the apex of the greater trochanter but at the base of the femoral neck in order to restore alignment of the nail with the femoral diaphysis.