COMPARATIVE STUDY OF OUTCOME OF FEMUR NAIL WITH ENTRY FROM PYRIFORMIS FOSSA VS GREATER TROCHANTER

DR. AMIT KUMAR; DR PIYUSH MITTAL

Volume : VI, Issue : XI, November - 2017

COMPARATIVE STUDY OF OUTCOME OF FEMUR NAIL WITH ENTRY FROM PYRIFORMIS FOSSA VS GREATER TROCHANTER

Dr. Amit Kumar, Dr Piyush Mittal

Abstract :

Intramedullary nailing is the best modality for femoral shaft fractures as it is biological fixation with good apposition with minimal tissue damage and fixation is bio mechanically superior to plates and fixators with immediate rehabilitation and fewer complications. ^(1,3,5)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 comp� the efficacy of the 2 entry points on various patient-and procedure-related outcomes.^(2,7,10) 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 OBJECTIVE

To compare the operative and fluoroscopic time required for IM nail fixation, time taken for taking entry ,the amount of blood loss, incision lenght 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 , LEM (lower extremity measure) and HHS (harris hip score) between the 2 entry points.

MATERIALS AND METHODS

The study included 50 patients with 25 in each group i.e greater trochanter and pyriformis fossa group. Only 2 part simple transverse fracture was taken into consideration.

DESIGN: Prospective comparative study

OBSERVATION AND RESULTS

GT entry showed better results as compared to PF group as there was statistical difference in total operative time , total fluoroscopy shoots taken, number of shoots while taking entry and incision lenth. These differences were magnified in obese patients with BMI>30. Functional outcome in terms of thorensen score , harriship score and radiological outcome in the form of union rates didn�t showed any statistical difference in both groups.

CONCLUSION

An antegrade femoral nail for trochanteric insertion resulted in equally high union rates, equally low complication rates, and functional results similar to conventional antegrade femoral nailing through the piriformis fossa. ^(3,8,9)The greater trochanter entry portal represents a rational alternative for antegrade femoral nailing with the benefit of decreased fluoroscopy time and decreased operative time in normal patients and benefits are more marked in those who are obese.