Prospective RCT comparing antegrade femoral intramedullary nailing through the piriformis fossa versus the greater trochanter in 110 adults with femoral shaft fractures, measuring hip function, muscle strength, heterotopic ossification, and intraoperative parameters at up to 12 months.
When planning antegrade femoral nailing, trochanteric entry with a laterally-bent nail delivers equivalent 1-year hip function with less OR time, a smaller incision, and dramatically less severe heterotopic ossification than piriformis fossa entry — favor it as your default unless anatomy dictates otherwise.
The rare exception is obesity or proximal fracture patterns where the piriformis start point may better align with the medullary canal.
Prospective RCT comparing antegrade femoral intramedullary nailing through the piriformis fossa versus the greater trochanter in 110 adults with femoral shaft fractures, measuring hip function, muscle strength, heterotopic ossification, and intraoperative parameters at up to 12 months.
When planning antegrade femoral nailing, trochanteric entry with a laterally-bent nail delivers equivalent 1-year hip function with less OR time, a smaller incision, and dramatically less severe heterotopic ossification than piriformis fossa entry — favor it as your default unless anatomy dictates otherwise.
The rare exception is obesity or proximal fracture patterns where the piriformis start point may better align with the medullary canal.