Nail designs started off with P, then moved to GT Tip to prevent AVN. Then now Lateral GT to prevent AVN further. (Lateral entry still goes through the GT and thus will affect the apophysis)
(Synthes is lateral GT entry point)
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Rates of AVN of various entry points?
Macneil et al. JPO 2011 Systematic review
Piriformis entry point AVN rate 2%, tip of GT 1.4%, lateral GT 0%
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What other concerns for femur nail?
Diameter of nail may not be small enough.
Smallest is 7mm (synthes)
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Complications?
Overgrowth of femur is common especially if < 2 yo