{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:59:49Z","timestamp":1773392389322,"version":"3.50.1"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Augsburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The exact positioning of the cephalomedullary (CM) nail entry point for managing femoral fractures remains debatable, with significant implications for fracture reduction and postoperative complications. This study aimed to explore the variability in the selection of the entry point among trauma surgeons, hypothesizing potential differences and their association with surgeon experience.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this prospective multicenter study, 16 participants, ranging from residents to senior specialists, partook in a simulation wherein they determined the optimal entry point for the implantation of a proximal femoral nail antirotation (PFN-A; DePuy Synthes) in various femora. The inter- and intra-observer variability was calculated, along with comprehensive descriptive statistical analysis, to assess the variability in entry point selection and the impact of surgeon experience.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In this study, the mean distance from the selected entry points to the calculated mean entry point was 3.98\u00a0mm, with a smaller distance observed among surgeons with more than 500 implantations (ANOVA, <jats:italic>p<\/jats:italic>\u2009=\u20090.050). Intra-surgeon variability for identical femora averaged at 5.14\u00a0mm, showing no significant differences across various levels of surgical experience or training. Notably, 13.6% of selected entry points would not allow a proper intramedullary positioning of the implant, thereby rendering anatomical repositioning unfeasible. Among these impossible entry points, a\u00a0significant skew towards anterior placement was observed (70.6% of the impossible entry points), with a smaller fraction being overly lateral (27.5%) or medial (13.7%). On a patient level, the impossibility rate varied widely from 0 to 35% among the different femora examined, with a significantly higher rate seen in younger patients (mean age 55.02 versus 60.32; <jats:italic>t<\/jats:italic>-test for independent samples, <jats:italic>p<\/jats:italic>\u2009=\u20090.04).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Significant variations exist in surgeons\u2019 selection of entry points for proximal femoral nailing, underscoring the task\u2019s complexity. Experience does not prevent the choice of unfeasible entry points, emphasizing the inadequacy of a universal approach and pointing towards the necessity for a patient-specific strategy for improved outcomes.<\/jats:p>\n                <jats:p><jats:italic>Trial registration number:<\/jats:italic> DRKS00032465.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s10195-024-00760-8","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T18:02:07Z","timestamp":1713895327000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Unravelling variations: an examination of entry point selection in proximal femoral cephalomedullary nailing"],"prefix":"10.1186","volume":"25","clinical-trial-number":[{"clinical-trial-number":"drks00032465","registry":"10.18810\/drks"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2194-4487","authenticated-orcid":false,"given":"Leonard","family":"Lisitano","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Wulff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Sieland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lutz","family":"Mahlke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timon","family":"R\u00f6ttinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jairo","family":"Cifuentes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edgar","family":"Mayr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim","family":"Rau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"issue":"6","key":"760_CR1","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1007\/s00068-011-0086-5","volume":"37","author":"CM Ansari Moein","year":"2011","unstructured":"Ansari Moein CM, Ten Duis HJ, Oey PL, de Kort GAP, van der Meulen W, van der Werken C (2011) Intramedullary femoral nailing through the trochanteric fossa versus greater trochanter tip: a randomized controlled study with in-depth functional outcome results. 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The study was classified as harmless by the ethics committee of the Ludwig Maximilians University in Munich. (Project Nr.: 21-1289).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All participating physicians were informed in detail about the use and publication of the data and gave their written consent. None of the investigations in this study have been previously published.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Leonard Lisitano, Laura Wulff, Lutz Mahlke, Timon R\u00f6ttinger, Jairo Cifuentes, Edgar Mayr and Kim Rau declare that they have no conflicts of interest. J\u00fcrgen Schmidt and Christoph Sieland declare their affiliation with metamorphosis GmbH but assert that there is no conflict of interest or any potential benefit from this study for them.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"23"}}