Ricci, J Orthop Trauma 2006 - Trochanteric versus Piriformis Entry Portal for the Treatment of Femoral Shaft Fractures

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Trochanteric versus Piriformis Entry Portal for the Treatment of Femoral Shaft Fractures

Ricci, Leighton, et al.·J Orthop Trauma·2006·127 citations·Prospective cohort

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Purpose

The purpose of this study was to compare results of femoral shaft fracture treatment with nailing through the greater trochanter to nailing through the piriformis fossa with nails specifically designed for each starting point.

Methods

Design: Prospective cohort study.

Setting: Four level 1 trauma centers.

Patients: One-hundred and eight patients treated by 1 of 4 surgeons for a femoral shaft or subtrochanteric fracture with antegrade nailing between January 2001 and April 2003 were included. Four patients who expired early in the postoperative period and 13 with insufficient follow-up were excluded from analysis.

Intervention: Patients were treated with either nailing through a greater trochanter starting point with the Trigen TAN nail (GT group) (n = 38) or through a piriformis fossa starting point with the Trigen FAN nail (PF group) (n = 53).

Outcome Measures: Operative time, fluoroscopy time, fracture alignment, fracture healing, complications, and functional outcome based on the lower-extremity measure (LEM).

Results

37 of the 38 fractures from the GT group and 52 of the 53 fractures from the PF group healed after the index procedure.
One patient from the GT group had external rotation malalignment of 12 degrees.
There were no other malalignments or iatrogenic fracture comminution.
There were 2 infectious complications, 1 from each group.
The average operative time was 75 minutes for piriformis insertion using the FAN nail and 62 minutes for trochanteric insertion using the TAN nail (P = 0.08).
The average fluoroscopy time was 61% greater for the PF group (153 seconds) than for the GT group (95 seconds) (P < 0.05).
These differences were magnified in patients who were obese (body mass index > 30) where the operative time was 30% greater (P < 0.05) and the fluoroscopy time was 73% higher in the PF group (P < 0.02).
Patients from both groups had a similar initial decline and subsequent improvement in function over time (P > 0.05).

Conclusions

A femoral nail specially designed 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. The greater trochanter entry portal coupled with an appropriately designed nail represents a rational alternative for antegrade femoral nailing with the benefit of decreased fluoroscopy time and decreased operative time in patients who are obese.

Copyright remains with the authors and publisher.

Trochanteric versus Piriformis Entry Portal for the Treatment of Femoral Shaft Fractures

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Acetabular Defect Classification and Surgical Reconstruction in Revision Arthroplasty. A 6-Year Follow-Up Evaluation.

Paprosky, Lawrence, et al.J Arthroplasty19941,213 citationsRetrospective cohort

Effects of Bracing in Adolescents with Idiopathic Scoliosis.

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Adolescent Idiopathic Scoliosis: A New Classification to Determine Extent of Spinal Arthrodesis.

Lenke, Blanke, et al.J Bone Joint Surg Am20011,720 citationsDiagnostic study

Problems in the Management of Type III (Severe) Open Fractures: A New Classification of Type III Open Fractures.

Gustilo, Williams, et al.J Trauma19842,361 citationsRetrospective cohort

Neer Award 2005: The Grammont Reverse Shoulder Prosthesis: Results in Cuff Tear Arthritis, Fracture Sequelae, and Revision Arthroplasty.

Boileau, Hovorka, et al.J Shoulder Elbow Surg20061,115 citationsProspective cohort

A System for the Surgical Staging of Musculoskeletal Sarcoma.

Enneking, Goodman, et al.Clin Orthop Relat Res19802,112 citationsRetrospective cohort

Fracture Fixation in the Operative Management of Hip Fractures (FAITH): An International, Multicentre, Randomised Controlled Trial.

Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) InvestigatorsLancet2017310 citationsRCT

Fatty Muscle Degeneration in Cuff Ruptures. Pre- and Postoperative Evaluation by CT Scan.

Goutallier, Voisin, et al.Clin Orthop Relat Res19942,669 citationsProspective cohort

Dislocations after Total Hip-Replacement Arthroplasties.

Lewinnek, Zimmerman, et al.J Bone Joint Surg Am19782,549 citationsRetrospective cohort

Morphologic Study of the Glenoid in Primary Glenohumeral Osteoarthritis.

Walch, Khoury, et al.J Arthroplasty19991,142 citationsRetrospective cohort

The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries.

DenisSpine (Phila Pa 1976)19832,566 citationsRetrospective cohort

The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency. A Minimum Two-Year Follow-Up Study of Sixty Patients.

Frankle, Vasey, et al.J Bone Joint Surg Am2005773 citationsRetrospective cohort

Randomized Trial of Reamed and Unreamed Intramedullary Nailing of Tibial Shaft Fractures.

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A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.

Vaccaro, Oner, et al.Spine (Phila Pa 1976)2005866 citationsConsensus statement

A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds.

FLOW Investigators, Guyatt, et al.N Engl J Med2015347 citationsRCT

Curve Progression in Idiopathic Scoliosis.

Weinstein, PonsetiJ Bone Joint Surg Am1983641 citationsRetrospective cohort

Traumatic Glenohumeral Bone Defects and Their Relationship to Failure of Arthroscopic Bankart Repairs: Significance of the Inverted-Pear Glenoid and the Humeral Engaging Hill-Sachs Lesion.

Burkhart, De BeerArthroscopy20001,884 citationsCase series

The Value of the Tip-Apex Distance in Predicting Failure of Fixation of Peritrochanteric Fractures of the Hip.

Baumgaertner, Keggi, et al.J Bone Joint Surg Am19951,441 citationsRetrospective cohort

Transchondral Fractures (Osteochondritis Dissecans) of the Talus.

Berndt, HartyJ Bone Joint Surg Am1959945 citationsBiomechanical study

Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis.

Weinstein, SPORT Investigators, et al.N Engl J Med20081,207 citationsRCT

The Lateral Pillar Classification of Legg-Calvé-Perthes Disease.

Herring, Browne, et al.J Pediatr Orthop1992461 citationsRetrospective cohort

Natural History of Asymptomatic Rotator Cuff Tears: A Longitudinal Analysis of Asymptomatic Tears Detected Sonographically.

Yamaguchi, Middleton, et al.J Shoulder Elbow Surg2001498 citationsRetrospective cohort

The Rotator Crescent and Rotator Cable: An Anatomic Description of the Shoulder's "Suspension Bridge".

Burkhart, Jolson, et al.Arthroscopy1993469 citationsAnatomic study

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O'Driscoll, Morrey, et al.J Bone Joint Surg Am1991997 citationsCase series

Preoperative versus Postoperative Radiotherapy in Soft-Tissue Sarcoma of the Limbs: A Randomised Trial.

O'Sullivan, Zee, et al.Lancet20021,587 citationsRCT

Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures. A Multicenter, Randomized Clinical Trial.

Canadian Orthopaedic Trauma SocietyJ Bone Joint Surg Am2007804 citationsRCT

Microvasculature of the Human Meniscus.

Arnoczky, WarrenAm J Sports Med19821,227 citationsAnatomic study

Metastatic Disease in Long Bones. A Proposed Scoring System for Diagnosing Impending Pathologic Fractures.

MirelsClin Orthop Relat Res19891,222 citationsRetrospective cohort

Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS).

Fehlings, Rampersaud, et al.PLoS One20121,200 citationsProspective cohort

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Robertson, Yamaguchi, et al.J Bone Joint Surg Am2000255 citationsAnatomic study

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NeerClin Orthop Relat Res19831,827 citationsReview article

Direct Decompressive Surgical Resection in the Treatment of Spinal Cord Compression Caused by Metastatic Cancer: A Randomised Trial.

Patchell, Young, et al.Lancet20052,356 citationsRCT

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Salter, HarrisJ Bone Joint Surg Am19631,737 citationsRetrospective cohort

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Burkhart, Kibler, et al.Arthroscopy2003929 citations

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Neer, Fukuda, et al.J Bone Joint Surg Am1983774 citationsCase series

A System of Staging Musculoskeletal Neoplasms.

EnnekingClin Orthop Relat Res19861,083 citationsReview article

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O'DriscollActa Orthop Belg199959 citationsReview article

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Wasielewski, Rubash, et al.J Bone Joint Surg Am1990290 citationsAnatomic study

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Hewett, Succop, et al.Am J Sports Med20053,495 citationsProspective cohort

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Sirveaux, Molé, et al.J Bone Joint Surg Br20041,598 citationsRetrospective cohort

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Sanders, Walling, et al.Clin Orthop Relat Res1993891 citationsProspective cohort

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Stulberg, Wallensten, et al.J Bone Joint Surg Am1981810 citationsRetrospective cohort

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Jobe, Lombardo, et al.J Bone Joint Surg Am1986758 citationsCase series

Replacement Arthroplasty for Glenohumeral Osteoarthritis.

NeerJ Bone Joint Surg Am1974598 citationsCase series

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HawkinsJ Bone Joint Surg Am1970556 citationsRetrospective cohort

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Stiell, Worthington, et al.JAMA20011,283 citationsProspective cohort

The Arterial Vascularization of the Humeral Head. An Anatomical Study.

Gerber, Vinh, et al.J Bone Joint Surg Am1990441 citationsAnatomic study

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Snyder, Friedman, et al.Arthroscopy19901,264 citationsCase series

Displaced Proximal Humeral Fractures. II. Treatment of Three-Part and Four-Part Displacement.

NeerJ Bone Joint Surg Am19701,283 citationsRetrospective cohort

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Rosenberg, Wesley, et al.Ann Surg19821,347 citationsRCT

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NeerJ Bone Joint Surg Am1972536 citationsCase series

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Griffin, FASHIoN Study Group, et al.Lancet2018542 citationsRCT

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Brooker, Riley, et al.J Bone Joint Surg Am19732,880 citationsRetrospective cohort

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Dejour, Guier, et al.Knee Surg Sports Traumatol Arthrosc19941,987 citationsCase-control study

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Morrey, Chao, et al.J Bone Joint Surg Am19811,380 citationsBiomechanical study

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Burkhart, Kibler, et al.Arthroscopy20031,304 citationsReview article

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Judet, Letournel, et al.J Bone Joint Surg Am1964980 citationsCase series

Inferior Capsular Shift for Involuntary Inferior and Multidirectional Instability of the Shoulder. A Preliminary Report.

Neer, FosterJ Bone Joint Surg Am1980934 citationsCase series

The Impact of Positive Sagittal Balance in Adult Spinal Deformity.

Glassman, Schwab, et al.Spine (Phila Pa 1976)20051,878 citationsRetrospective cohort

An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries.

Bosse, Castillo, et al.N Engl J Med2002901 citationsProspective cohort

Normal and Abnormal Motion of the Shoulder.

Poppen, WalkerJ Bone Joint Surg Am1976886 citationsCase-control study

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Harms, MelcherSpine (Phila Pa 1976)20011,528 citationsCase series

A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures.

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Hoffman, Zucker, et al.N Engl J Med20001,302 citationsProspective cohort

Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture

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SwansonJ Hand Surg Am1976429 citationsReview article

Treatment of Grade IV Fracture-Dislocation of the Hip.

PipkinJ Bone Joint Surg Am1957445 citationsCase series

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Anderson, Park, et al.J Bone Joint Surg Am1975416 citationsCase series

Legg-Calve-Perthes Disease. Part II: Prospective Multicenter Study of the Effect of Treatment on Outcome.

Herring, Browne, et al.J Bone Joint Surg Am2004143 citationsProspective cohort

The Role of the Scapula in Athletic Shoulder Function.

KiblerAm J Sports Med19981,240 citationsReview article

The SLAC Wrist: Scapholunate Advanced Collapse Pattern of Degenerative Arthritis.

Watson, BalletJ Hand Surg Am19841,138 citationsRetrospective cohort

Classification and an Algorithmic Approach to the Reconstruction of Femoral Deficiency in Revision Total Hip Arthroplasty.

Valle, PaproskyJ Bone Joint Surg Am2003199 citationsRetrospective cohort

The Tibial Plateau Fracture. The Toronto Experience 1968--1975.

Schatzker, Bruce, et al.Clin Orthop Relat Res19791,029 citationsRetrospective cohort

Surgical Dislocation of the Adult Hip a Technique with Full Access to the Femoral Head and Acetabulum without the Risk of Avascular Necrosis.

Ganz, Berlemann, et al.J Bone Joint Surg Br20011,367 citationsCase series

Predictors of Humeral Head Ischemia after Intracapsular Fracture of the Proximal Humerus.

Hertel, Leunig, et al.J Shoulder Elbow Surg2004837 citationsProspective cohort

Early versus Delayed Stabilization of Femoral Fractures. A Prospective Randomized Study.

Bone, Scheinberg, et al.J Bone Joint Surg Am1989795 citationsRCT

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LetournelClin Orthop Relat Res1980715 citationsRetrospective cohort

A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group.

Fisher, Fourney, et al.Spine (Phila Pa 1976)20101,224 citationsConsensus statement

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Rangan, PROFHER Trial Collaborators, et al.JAMA2015540 citationsRCT

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WeberSpine (Phila Pa 1976)19831,149 citationsRCT

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Trochanteric versus Piriformis Entry Portal for the Treatment of Femoral Shaft Fractures

Ricci, Leighton, et al.·J Orthop Trauma·2006·127 citations·Prospective cohort

|

Purpose

The purpose of this study was to compare results of femoral shaft fracture treatment with nailing through the greater trochanter to nailing through the piriformis fossa with nails specifically designed for each starting point.

Methods

Design: Prospective cohort study.

Setting: Four level 1 trauma centers.

Patients: One-hundred and eight patients treated by 1 of 4 surgeons for a femoral shaft or subtrochanteric fracture with antegrade nailing between January 2001 and April 2003 were included. Four patients who expired early in the postoperative period and 13 with insufficient follow-up were excluded from analysis.

Intervention: Patients were treated with either nailing through a greater trochanter starting point with the Trigen TAN nail (GT group) (n = 38) or through a piriformis fossa starting point with the Trigen FAN nail (PF group) (n = 53).

Outcome Measures: Operative time, fluoroscopy time, fracture alignment, fracture healing, complications, and functional outcome based on the lower-extremity measure (LEM).

Results

37 of the 38 fractures from the GT group and 52 of the 53 fractures from the PF group healed after the index procedure.
One patient from the GT group had external rotation malalignment of 12 degrees.
There were no other malalignments or iatrogenic fracture comminution.
There were 2 infectious complications, 1 from each group.
The average operative time was 75 minutes for piriformis insertion using the FAN nail and 62 minutes for trochanteric insertion using the TAN nail (P = 0.08).
The average fluoroscopy time was 61% greater for the PF group (153 seconds) than for the GT group (95 seconds) (P < 0.05).
These differences were magnified in patients who were obese (body mass index > 30) where the operative time was 30% greater (P < 0.05) and the fluoroscopy time was 73% higher in the PF group (P < 0.02).
Patients from both groups had a similar initial decline and subsequent improvement in function over time (P > 0.05).

Conclusions

A femoral nail specially designed 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. The greater trochanter entry portal coupled with an appropriately designed nail represents a rational alternative for antegrade femoral nailing with the benefit of decreased fluoroscopy time and decreased operative time in patients who are obese.

Copyright remains with the authors and publisher.

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