Geometric mismatch analysis of retrograde nail in the Asian femur

The geometric mismatch analysis of the retrograde nail was performed in 108 Asian cadaveric adult femora. The insertion was done virtually based on a three-dimensional geometric model derived from computed tomographic images. The investigation was performed at eight levels located at 120, 140, 160, 180, 200, 220 and 240 mm above the condylar surface. The evaluation of each level included: (1) the diameter of the intramedullary canal, (2) the percentage of area filled by the nail in the unreamed intramedullary canal, (3) the minimal reamer diameter that required enlargement of the canal to accommodate retrograde nail insertion, (4) the minimal inner cortical reaming thickness that needed to be removed, (5) the percentage of the cortical bone area that needed to be removed prior to nail insertion and (6) the deviation of the nail center from the center of the intramedullary canal. The result showed significant mismatch of the nail to most of the study specimens (94 femora, 87%), which the intramedullary canal needed extensive reaming to accommodate the nail insertion. This may lead to a high possibility of clinical complications. Redesign for proper shape and size of retrograde nail should be considered for the use in Asian population.