The Treatment of IM Nailing of Femoral Shaft Fracture: Piriformis Fossa versus Trochanteric Entry Portal

Hyun Kook Youn; Oog Jin Shon; Dong Sung Han

doi:10.12671/jkfs.2008.21.3.200

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Youn, Shon, and Han: The Treatment of IM Nailing of Femoral Shaft Fracture: Piriformis Fossa versus Trochanteric Entry Portal

Original Article

Journal of the Korean Fracture Society 2008; 21(3): 200-206.

Published online: 31 July 2008

DOI: https://doi.org/10.12671/jkfs.2008.21.3.200

The Treatment of IM Nailing of Femoral Shaft Fracture: Piriformis Fossa versus Trochanteric Entry Portal

Hyun Kook Youn, M.D., Oog Jin Shon, M.D., Dong Sung Han, M.D.

Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea.

Address reprint requests to: Oog Jin Shon, M.D. Department of Orthopaedic Surgery, Yeungnam University Medical Center, 317-1, Demyung-dong, Nam-gu, Daegu 705-717, Korea. Tel: 82-53-620-3640, Fax: 82-53-628-4020, ossoj@med.yu.ac.kr

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the results of IM nailing of femur shaft fractures using trochanteric and piriformis fossa entry portal.

Materials and Methods

37 patients were treated with IM nail using Trochanteric (Trochanter group: TG, n=17) and piriformis fossa entry portal (piriformis group: PG, n=20) and were followed from February 2004 to 2007. The outcomes were assessed based on the clinical and radiographic findings.

Results

The functional result, ROM and union time were similar in both groups. The alignment was similar in both groups but PG showed variable alignment in proximal 1/3. Incision was larger in PG (PG=8.7 cm, TG=5.8 cm, p<0.05) and there was a difference between overweight and normal weight group. Operative time was 95 minutes in PG, 87 minutes in TG (p>0.05), there was statistically significant difference in overweight groups (PG=125 minutes, TG=90 minutes, p<0.05). Blood loss was 313 cc in PG, 268 cc in TG and less in TG in overweight patients (p<0.05). There was 5.7° of varus angulation in PG, 2 nonunion cases in both groups.

Conclusion

The femoral nail specially designed for trochanteric insertion resulted in high union rates, low complication rates similar to conventional nail and the trochanteric nail can be the alternative choice especially in proximal femur fracture and overweight patients.

Keywords: Trochanteric, Piriformis fossa, Femur shaft fracture, Intramedullary nail

Figures and Tables

Fig. 1

(A, B) Anteroposterior and lateral radiograph of 25-years-old male injured by car injury, resulting a proximal femur shaft fracture.

(C, D) Radiographs taken at 1 year after cannulated femoral nail insertion via piriformis fossa. 4° varus of alignment was noted.

Fig. 2

(A, B) Anteroposterior and lateral radiograph of 72-years-old female injured by fall down, resulting a proximal femur shaft fracture.

(C, D) Radiographs taken at 1 year after Sirus® femoral nail insertion via greater trochanter tip.

Table 1

Summary of cases

^*PF: Piriformis group, ^†TC: Trochanter group, ^‡BMI: Body mass index.

Table 2

Cause of injury

^*PF: Piriformis group, ^†TC: Trochanter group.

Table 3

Relationships of associated injury level, fracture type and entry point

^*PF: Piriformis group, ^†TC: Trochanter group, ^‡W-H: Winquist-Hansen.

Table 4

Comparison of postoperative and intraoperative data between piriformis nail and trochanter nail group

^*PF: Piriformis group, ^†TC: Trochanter group.

Table 5

Comparison of postoperative range of motion and alignment between piriformis nail and Trochanter nail group

^*PF: Piriformis group, ^†TC: Trochanter group.

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