Diab MM, et al. - Researchers designed this work to evaluate the impact of antegrade SIGN intramedullary (IM) nailing start site on radiographic alignment and health-related quality of life. Findings revealed that lateral start site was associated with varus malalignment. Despite nonsignificant association of lateral start site with reoperation, varus deformity seemed to have a correlation with higher reoperation rates. They recommended surgeons consider avoiding a start site lateral to the tip of the greater trochanter or allow the nail to rotate to avoid malalignment when using the SIGN nail for proximal femur fractures.