Biomechanical strain analysis of the proximal femur after retrograde intramedullary nailing

Background The purpose of this study was to examine the influence of proximal retrograde intramedullary nail position on proximal femoral strain, since stress risers occurring at the end of an implant can increase fracture risk. Methods Proximal femoral strains during axial and torsional loading were measured in composite Sawbone femurs after placement of retrograde intramedullary nails that ended at three different locations (2 cm proximal, 4 cm distal, and at the level of the lesser trochanter). Results No statistically significant difference was found between the axial or torsional strain observed in the intact femur and that seen after placement of a retrograde femoral nail ending at any of the three positions. Gauges proximal to the nail tip demonstrated higher strains than the strains for the intact femur when compared with gauges distal to the nail tip. Conclusion The ending location of a retrograde nail in the proximal femur does not appear to significantly alter strain in the proximal femur under the axial and torsional loading methods used in the study.