Incidence of Varus Malalignment Post Interlocking Nail in Proximal Femur Shaft Fractures Comparing Two Types of Entry Points

Abstract

Introduction: Osteosynthesis of the femur using an interlocking nail is the gold standard for treating diaphyseal fractures of the femur. There are two established entry points for the antegrade interlocking nails which is the piriformis fossa or the greater trochanter. It has been reported that varus malalignment was frequently seen in proximal femur fracture which were treated with interlocking nail utilizing the greater trochanter entry point. The study was done to find out if the problem was of significance.Materials and Methods: This was a retrospective study which included 179 patients with femur fractures which were treated from January 2013 till September 2015 in one Hospital. They were treated with interlocking nail either by utilizing the piriformis fossa (PF) or the greater trochanter (GT) entry points. Post-operative radiographs of the femur were used to measure the varus deformity.Results: Out of 179 patients, there were 5 patients who were reported to have unacceptable varus malalignment (2.79%). These 5 patients were out of the 88 (5.68%) patients utilizing the greater trochanter as the entry point. The same 5 patients were out 90 patients that were diagnosed with proximal femur shaft fractures (5.55%). Analysis with logistic regression was statistically not significant.Conclusion: There was higher rate of varus malalignment seen in proximal femur shaft fractures treated with interlocking nails utilizing the greater trochanter entry point. The incidence of varus malalignment was not significant statistically.

Optimal entry point for antegrade and retrograde femoral intramedullary nails

“…Considering intra-operative time and fluoroscopy exposure, both were significantly less in greater trochanteric nails when compared to piriformis entry. 17 , 18 The mean operative time for the greater trochanteric entry was 90.7 min vs. 112.7 min for the piriformis entry, while the fluoroscopy time was 5.88 seconds for the greater trochanteric entry and 10.08 seconds for piriformis entry group. 19 …”

Kinesiophobia in a Patient With Postoperative Midshaft Fracture: A Case Report of Its Impact on Rehabilitation in a 16-Year-Old Girl

“…Phase III (6)(7)(8)(9)(10)(11)(12) In order to improve mobility, balance, proprioception, and agility training, the focus of the exercises was on increasing the power of the lower limb by partial weight-bearing activities during phase III.…”

“…Early fracture fixation in the shaft of the femur allows for early mobilization, thereby reducing the risk of hip and knee stiffness as well as quadriceps and hamstring wasting. Intramedullary nail restores the shaft length and enables early load-bearing [ 6 ].…”