Short segment coronal plane stability screws in retrograde nailing of proximal femoral shaft fractures: a technical trick and case series

Retrograde intramedullary nailing is commonly used for fixation of femoral shaft fractures due to high healing rates and ease of placement. However, for proximal femur fractures, there is concern that the limited distance between the fracture and proximal interlock fixation may predispose these fractures to varus deformity and malunion. Coronal plane stability screws placed just adjacent to the outer diameter of the intramedullary nail can be used to counteract this coronal plane deformity but can be difficult to place proximally due to limitations from body habitus and difficulty with fluoroscopic imaging. This report demonstrates a technique for coronal plane stability screw placement utilizing manipulation of a proximal interlock aiming arm to aim screws just medial and lateral to the proximal implant. A case series of 8 patients who underwent retrograde intramedullary nailing placement with coronal plane stability screws is presented and demonstrates high rates reduction maintenance of the neck shaft angle and femoral mechanical axis, low complication, and high rates of union and functional recovery. This technique is reproducible, simple, and has the potential to provide increased proximal small-segment stability, particularly in patients with large body habitus or those with severe concomitant injuries preventing safe antegrade nail placement.