Percutaneous manipulation of an osteoarthritic hip for femoral nailing

An increasing number of elderly patients with femoral shaft fractures also have coexisting osteoarthritis of the hip. This proves to be difficult both in fracture reduction [1] and localisation of the point of entry into the piriform fossa. To facilitate guide wire entry in a patient with osteoarthritis of the hip, considerable adduction of the hip may be required during conventional closed antegrade femoral nailing. We describe a technique using a Steinman pin on a T-clamp to facilitate localisation of the piriform fossa.