Session II - Femur

Thurs., 10/5/06 Femur, Paper #9, 3:54 pm

Functional Outcomes following Intramedullary Nailing of the Femur: A Prospective Randomized Comparison of Piriformis versus Trochanteric Nailing

James P. Stannard, MD1 (a-Smith+Nephew); Larry Bankston, MD1 (n); Lydia A. Futch, MSPT, ATC2 (n); Gerald McGwin, Jr, PhD1 (n); David A. Volgas, MD1 (a-Smith+Nephew);
1University of Alabama at Birmingham, Birmingham, Alabama, USA;
2UAB Sports Medicine, Birmingham, Alabama, USA

Purpose: Our objective is to prospectively evaluate the functional outcomes of intramedullary nailing of the femur comparing the trochanteric versus piriformis entry portals.

Methods: 97 patients have been enrolled in our prospective, randomized, blinded study to date. 49 patients in Group A (Piriformis) and 48 in Group B (Trochanteric) have been randomized. Intraoperative data has been gathered on all patients, as well as long-term outcome data. Outcome measures have included WOMAC hip scores, pain scores, SF-36 scores, and blinded functional evaluations by a physical therapist.

Results: Intraoperative data comparing the two groups demonstrates significant benefits to trochanteric nailing. The mean operative time for patients in Group A was 104 compared to 71 minutes in Group B (P <0.0001). Fluoroscopy time was also significantly different, with 151 seconds (Group A) compared to 107 seconds (Group B) (P = 0.0005). Mean incision length was 71 mm (A) compared to 38 mm (B) (P <0.0001). Analog pain scale values showed a trend in favor of Group B (1.8) compared to Group A (3.4) at 6-12 months postoperative (P = 0.11). WOMAC scores at 3 and 6 months are not significantly different, but Group B had slightly better scores in both cases. Functional tests included the chair stand test and the timed up & go. Group B patients had significantly better scores on the chair stand (15.3 compared to 9.5, P =0.005) at 6 months and a trend toward better scores at 12 months (14.4 vs. 12.6). There were no significant differences between the two groups in the timed up & go, although patients in Group B had slightly better scores than those in Group A at both 6 and 12 months.

Conclusion: In our prospective randomized study, patients who were treated with trochanteric nailing had significantly better outcomes in all intraoperative parameters measured. Functional outcome testing has generally demonstrated trends in favor of trochanteric nailing, although most of the outcomes are not significantly different at current enrollment. Our data indicate that trochanteric nailing is easier to accomplish in most patients, with functional outcomes that are at least as good as those obtained in patients treated with piriformis fossa nails.

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.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.