Determining the Optimal Level of Proximal Locking Screwe Insertion in Femoral Nailing

Objective: the aim is to investigate the optimum level of insertion for proximal locking screw in the proximal femurs.material-method: the distance between the trochanteric fossa and lesser trochanter and the medial- lateral femur canal diameters 20 mm proximal and 20 mm distal to the lesser trochanter within an intervals of 10 millimeters on ap radiograms of 208 patients in both genders and different age groups were measured.results: the average distances between the trochanteric fossa and lesser trochanter level were 60.8 mm in male and 52.2 mm in female populations (p=0.000). the average femoral canal diameter at the level of the lesser trochanter was 29.2 ± 4.3 mm, whereas 10 mm proximal to the lesser trochanter it was 39 ± 4.6 mm, the difference was statistically significant with p=0.000.conclusions: lesser trochanter level is the optimal level for transverse proximal locking screw insertion since it contains the relatively narrowest canal in the proximal femur. orthopedic surgeons should be aware of choosing the femoral nails with a proximal tip to proximal screw hole distance of a 61 mm in male and a 52 mm in female populations to increase three point bending resistance of proximal locking screw and to prevent early implant failure.