The diaphysis of the femur is surrounded by a thick muscular envelope. The major neurovascular structures are located medially and, therefore, the femur can be safely approached over the anterolateral region.
Overall neurovascular status of the limb
For the pin insertion, the state of the soft-tissue envelope of the femoral shaft has to be considered (areas of crush injuries, or areas of extensive soft-tissue damage should be avoided, in order to minimize the risk of subsequent pin-track infection).
Conversion of temporary external fixator to nailing, or plating
Care should be taken for pin placement in cases where the external fixator is used as a temporary device and where the external fixator is to be converted either to an intramedullary nail, or a plate fixation, at a later stage.