Session V - Femur

Fri., 10/21/05 Femur, Paper #22, 11:06 am

Piriformis versus Trochanteric Antegrade Nailing of Femoral Fractures: A Prospective Randomized Study

James P. Stannard, MD (a-Smith+Nephew, Inc.); Larry Bankston, MD (n); Lydia A. Futch, MSPT (n); Lisa C. Altamirano, MSPT, CSCS (n);
Gerald McGwin, Jr., PhD (n); David A. Volgas, MD (n);
University of Alabama at Birmingham, Birmingham, Alabama, USA

Purpose: This study was designed to compare the piriformis and trochanteric starting points for antegrade intramedullary nailing of femoral shaft fractures.

Methods: This study is a prospective, IRB-approved clinical trial with patients randomized to either Group A (piriformis fossa) or Group B (trochanteric start point). Data have been collected regarding surgical and fluoro time, incision length, blood loss, Injury Severity Score (ISS), location of fracture, and demographics. Additional data obtained at follow-up includes Womack score, radiographic and clinical healing, and functional evaluation of hip muscles at 6 and 12 months.

Results: 27 patients have been randomized to Group A and 28 to Group B with current enrollment. The mean ISS for Group A is 23, compared to 16 for Group B. Group A patients had a mean surgical time of 104 minutes, fluoro time of 163 seconds, estimated blood loss (EBL) of 346 cc, and incision length of 74 mm. In comparison, Group B patients had a mean surgical time of 74 minutes, fluoro time of 108 seconds, EBL of 183 cc, and incision length of 40 mm. All of these data points are significantly different with P values <0.01 in favor of the trochanteric start point. Group A patients took a mean of 117 days to achieve radiographic union and 150 days to achieve clinical union. Group B patients took 127 days to achieve radiographic union and 98 days to achieve clinical union. The difference in time to clinical union was significant (P<0.05). A blinded evaluation of hip muscle strength and function is being obtained by a physical therapist. There is a trend toward improved function with the trochanteric nail start point, but the difference is not significant at this time. Womack scores for Group A were 31 at 6 months and 23 at 12 months, compared to 29 and 21 for Group B. Although the difference is not significant, the scores for Group B were slightly better at both time intervals.

Conclusion: Intramedullary nails using the trochanteric start point have been developed recently. Intraoperative data from our prospective randomized study demonstrate that using the trochanteric starting point is significantly quicker, requires less fluoro time, and reduces blood loss and incision length. Early functional evaluation is not significantly different between the groups, although there is a slight trend in favor of trochanteric nailing with all measures.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.