Neurologic and Vascular Structures at Risk during Anterior-Posterior Locking of Retrograde Femoral Nails

Objective: To evaluate the neurovascular structures at risk with the placement of anterior-posterior locking screws in the proximal femur. Design: Cadaveric study. Main Outcome Measure: Anatomic relationships. Results: The femoral artery lies medial to the femur, and its branches cross the anterior femur more than four centimeters distal to the lesser trochanter. Branches of the femoral nerve cross the anterior femur proximal to the lesser trochanter and start four centimeters distal to the piriformis fossa. Conclusions: Risks to the neurovascular structures during anterior-posterior locking in the proximal femur are diminished if locking is performed above the level of the lesser trochanter.