Projection marking to optimize antegrade femoral intramedullary nailing

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Objective To evaluate the projection marking which was designed to improve the surgical efficiency of antegrade femoral intramedullary nailing for femoral intertrochanteric and shaft fractures. Methods A total of 198 patients (158 femoral intertrochanteric fractures and 40 femoral shaft fractures) were analyzed retrospectively who had been treated at Department of Orthopedics, The First Affiliated Hospital to Wenzhou University from January 2012 to January 2016. They were 61 males and 137 females, aged from 13 to 95 years (mean, 65.4±14.6). By AO classification, there were 55 cases of type 31-A1, 103 cases of type 31-A2, 21 cases of type 32-A2 and 19 cases of type 32-A3. The intertrochanteric fractures which had been treated from January 2012 to May 2013 with no projection marking were assigned into group A1 (n=61) while the shaft fractures which had been treated in the same period with no projection marking into group B1 (n=12); the intertrochanteric fractures which had been treated from May 2013 to January 2016 with projection marking were assigned into group A2 (n=97) while the shaft fractures which had been treated in the same period with projection marking into group B2 (n=28). Comparisons were made between groups A1 and A2, and between groups B1 and B2 in terms of total operative time, total number of fluoroscopy, complications, Harris hip score (HHS), and pain and symptoms scores in Knee Injury and Osteoarthritis Outcome Score (KOOS) 3 months after operation. Results The 198 patients were followed up for 3 to 18 months (average, 7.0 months). The total operative time (56.5±6.6 min) and the total number of fluoroscopy (26.6±6.2 times) in group A2 were significantly less than those in group A1 (59.2±9.2 min and 31.4±9.9 times) (P 0.05). Conclusion The self-designed designed method of projection marking can reduce operative time and number of intraoperative fluoroscopy in the antegrade femoral intramedullary nailing for femoral intertrochanteric and shaft fractures. Key words: Femoral fractures; Fracture fixation, internal; Bone nails; Projection marking