Abstract
Antegrade femoral nailing through the greater trochanter, using nails designed for piriformis entry, is associated with varus and iatrogenic comminution. Nails designed for greater trochanter insertion theoretically reduce these complications, but clinical outcomes comparing these to piriformis entry remain unknown. We compared femoral shaft fracture repair with a nail designed for trochanteric entry to an identical nail without a trochanteric bend inserted through the piriformis fossa.
The trochanteric nail was easier to insert with decreased operative and fluoroscopy time. It resulted in equally high union rates, low complication rates, and functional results similar to conventional nailing through the piriformis fossa.
Trochanteric antegrade nailing of the femur is thought to be advantageous over conventional antegrade nailing due to improved ease of insertion, but is unproven. This study compares results of femoral shaft fracture treatment using a nail designed specifically for trochanteric entry, Trigen TAN, to results using an identical nail without a trochanteric bend inserted through the piriformis fossa, Trigen FAN.
A femoral nail specially designed for trochanteric insertion resulted in equally high union rates, equally low complication rates, and functional results similar to conventional antegrade femoral nailing through the piriformis fossa. As a result of increased ease of insertion, decreased operative time and decreased fluoroscopy time, the greater trochanter entry portal, coupled with an appropriately designed nail, represents a rational alternative for antegrade femoral nailing.
Insertion of a specially designed femoral nail though the trochanter is faster, easier, and requires less fluoroscopy time than conventional antegrade nailing through the piriformis fossa.
Overall, there was < 10° malalignment and no iatrogenic fracture comminution. The average operative time was 21% greater using the FAN nail than using the TAN nail, (p=.08). The average fluoroscopy time was 61% greater for the FAN group than for the TAN group, (p< .05). Trends in functional outcome (Lower Extremity Measure) were similar for both groups.
One hundred and eight patients treated for a femoral shaft fracture were included in this study. Ninety-eight patients were treated with either a Trigen TAN nail (n=38) or Trigen FAN nail (n=53); seventeen patients with insufficient follow-up were excluded from analysis.
Funding:Smith & Nephew, Memphis TN
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
