Trochanteric entry VS piriformis entry in case of antegrade nailing of femoral shaft fracture treatment: A prospective randomised comparative study

Abstract

Background: Intramedullary nailing is the best modality for femoral shaft fractures as it is biological fixation with good apposition with minimal tissue damage and fxation is bio mechanically superior to plates and fixators with immediate rehabilitation and fewer complications. The optimal entry point for antegrade intramedullary nailing of femoral shaft fractures remains controversial. Since the study by Ricci et al, there have been a number of randomized, controlled trials (RCTs) and cohort studies comparing the efficacy of the 2 entry points on various patient-and procedure-related outcomes. As per our knowledge, there has been very less systematic review of the literature on optimal entry point during antegrade nailing of femoral shaft fracture. Aims and ObjectivesAims: To compare the operative and fluoroscopic time required for IM nail fixation, time taken for taking entry, the amount of blood loss, and other complication in the form of iatrogenic neck femur fracture in surgery of femoral shaft fractures using the GT (greater trochanter) versus PF (Pyriformis fossa) entry point. A secondary objective was to determine whether there were any differences in complications (delayed and non union), fracture alignment and healing and functional outcomes in the form of thorensen score, and HHS (harris hip score) between the 2 entry points. Materials and Methods: The present pilot project was conducted in a time span of 2 year and 4 months. The patients admitted with femoral diaphyseal fractures were alternately selected for antegrade nailing through PF group and greater trochanter entry (GTE group) approach. Total number of patient in each group was 30 (n = 30).