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

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 o 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.