Results of Intramedullary Nailing of Femoral Shaft Fracture - Trochanteric Entry Portal (Sirus Nail) versus Piriformis Entry Portal (M/DN Nail) -

Sang Ho Ha; Woong-Hee Kim; Gwang Chul Lee

doi:10.12671/jkfs.2014.27.1.50

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Ha, Kim, and Lee: Results of Intramedullary Nailing of Femoral Shaft Fracture - Trochanteric Entry Portal (Sirus Nail) versus Piriformis Entry Portal (M/DN Nail) -

Original Article

Journal of the Korean Fracture Society 2014; 27(1): 50-57.

Published online: 17 January 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.1.50

Results of Intramedullary Nailing of Femoral Shaft Fracture - Trochanteric Entry Portal (Sirus Nail) versus Piriformis Entry Portal (M/DN Nail) -

Sang Ho Ha, M.D., Woong-Hee Kim, M.D., Gwang Chul Lee, M.D.

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to: Gwang Chul Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, leekci@chosun.ac.kr

Received 13 September 2013 Revised 21 October 2013 Accepted 16 December 2013

(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 treatment results obtained using the trochanteric (Sirus nail) entry portal with those obtained using the Piriformis fossa (M/DN) entry portal during intramedullary (IM) nailing of femur shaft fractures.

Materials and Methods

Four hundreds and thirty-two patients treated for femur shaft fracture using IM nails from February, 2001 to May, 2010 were divided into two groups. group 1 was composed of 180 patients treated through the trochanteric (Sirus nail; n=180) entry portal, while group 2 contained 170 patients treated through the piriformis fossa (M/DN nail; n=170) entry portal. We compared the clinical and radiographic findings of both groups to evaluate the treatment results.

Results

Functional result, range of motion and union time (18, 20 weeks) were similar in both groups. The operation time of patients in the over-weighted group was 90 minutes in group 1 and 120 minutes in group 2 (p<0.05). Additionally, the blood loss was 280 ml in group 1 and 335 ml in group 2, and in case of over-weight patients, group 2 showed more blood loss (p<0.05). The duration of exposure to fluoroscopy differed slightly, with group 1 being less exposed than group 2; however, this difference was not significant (p>0.05). There were 18 iatrogenic fractures in group 1 and 4 in group 2 (p<0.05).

Conclusion

There was not much difference in complications based on clinical and radiographic findings of both groups. For groups using the trochanteric entry portal, the operation time was shorter and blood loss was lower than in groups using the piriformis entry portal. Iatrogenic fracture occurred more often in the group using the trochanteric entry portal than in the group using the piriformis entry portal.

Keywords: Trochanter, Piriformis fossa, Femoral fracture, Internal fixation, Intramedullary Nail, Sirus, M/DN

Figures and Tables

Fig. 1

(A) Trochanteric entry portal: the correct location for the trochanteric entry point immediately next to the tip of the greater trochanter on the anteroposterior view and exactly centered on the axial view. (B) Piriformis entry point: the correct position for the piriformis fossa entry point is immediately medial to the tip of the greater trochanter.

Fig. 2

(A) Anteroposterior and lateral radiograph of a 21-year-old male who received a femur midshaft fracture in a traffic accident. (B) Postoperative radiograph: iatrogenic fracture (arrow) during closed nailing of the femoral shaft fracture via the trochanteric tip. (C) Anteroposterior and lateral radiographs of femoral diaphyseal nonunion after 4 months. Nail dynamization was performed, femoral diaphyseal nonunion (arrows). (D) Bone union observed on radiographs taken 2 years after operation. (E) After implant removal.

Table 1

Patients Characteristics

Values are presented as number only or median (range).

Table 2

Fracture Characteristics

OTA classification 32A: simple fractures, 32B: wedge fractures, 32C: complex fractures. Open grade: Gustilo classification.

Table 3

Comparison of Results

Values are presented as number only or median (range).

Notes

This study was supported by research fund from Chosun University Hospital, 2011.

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