LETTER TO THE EDITOR Miss-A-Nail Technique for Neck of Femur Screw Fixation: It Is Easier Said Than Done

Antegrade nailing is considered the “gold standard” in treating femoral shaft fractures1 . Peri-implant fractures occurring at the femoral neck in young adults are uncommon. Femoral neck fractures occurring in young adults are often due to high-energy trauma1 . Treatment of femoral neck fractures are often performed with open or closed reduction with cannulated or non-cannulated screw fixation1 . With an antegrade femoral nail in situ, it complicates the neck of femur fixation. One option includes removing the previous implant prior to inserting the screws for the neck of femur fractures. However, removal of the implant may cause iatrogenic fractures. The removal may not be feasible due to the overgrowth of bone on top of the nail and locking screws insertion sites1 . Any attempt to remove the previous implant with invasive maneuvers risks further displacement of the neck of femur fracture and increases the risk of avascular necrosis of the femoral head. Miss-A-Nail technique can be performed for femoral neck screw fixation with the femoral nail in situ.