Choice of Entry Point Does Not Affect Clinical and Radiological Outcomes in Antegrade Intra-medullary Nailing in Patients with Shaft of Femur Fracture: A Prospective Randomized Controlled Trial

• Published in: Indian journal of orthopaedics Vol. 58; no. 4; pp. 339 - 344
• Main Authors: Gaurav, Ankit, Kumar, Prasoon, Sudesh, Pebam, Prakash, Mahesh, Meena, Shyam Charan, Patel, Sandeep, Kumar, Vishal
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.04.2024
• Subjects: Conservative Orthopedics; Medicine; Medicine & Public Health; Original Article; Orthopedics; Surgical Orthopedics; Femur shaft fracture; Entry point; Piriformis fossa; Intramedullary nailing; Blood loss; Greater trochanter; Radiological outcomes; AVN hip; Clinical outcomes
• ISSN: 0019-5413; 1998-3727
• DOI: 10.1007/s43465-024-01104-8

Purpose The choice of entry point, Greater trochanter (GT), or Piriformis entry (PE) for antegrade intramedullary nailing (IMN) of the femur is crucial. This study was performed to compare these two entry points in the patients with shaft of femur fractures regarding intra-operative parameters, radiological and functional outcomes. Materials and Methods Twenty-four patients underwent GT entry nailing, while 25 patients underwent PE nailing. Surgical time, Intra-operative blood units transfused, Intra-operative fluoroscopy exposure by number of C-arm shots taken, mean drop in hemoglobin, and incidence of iatrogenic fracture were recorded. Patients were followed up at 4 weeks, 6 weeks, and 6 months to look for radiological healing and improvements in functional outcome using Modified Harris Hip Score (MHHS). MRI of bilateral hips with pelvis was done in 25 patients at 6 months of follow-up to detect any preliminary signs of AVN. Results The mean drop in hemoglobin in the GT group was significantly lesser than the PE group ( p  = 0.02). Mean MHHS at 4 weeks post-op was also significantly higher in the GT group ( p  = 0.01). There was no significant difference between both the groups regarding surgical duration, fluoroscopy exposure, radiological and functional outcomes in the long term. None of the patients who underwent MRI displayed any preliminary sign of AVN. Conclusion GT entry nails lead to lesser surgical time, fluoroscopy exposure, and intra-operative blood loss. Both the nailing systems achieve excellent fracture unions and comparable functional outcomes in the long term, and there is a minuscule risk of AVN in adult patients undergoing IMN.