Stannard, J Bone Joint Surg Am 2011 - Functional Outcome Following Intramedullary Nailing of the Femur: A Prospective Randomized Comparison of Piriformis Fossa and Greater Trochanteric Entry Portals - Article Summary

Functional Outcome Following Intramedullary Nailing of the Femur: A Prospective Randomized Comparison of Piriformis Fossa and Greater Trochanteric Entry Portals

Stannard, Volgas, et al.·J Bone Joint Surg Am·2011·48 citations·RCT

Background

The purpose of the study was to prospectively compare the functional outcome of intramedullary nailing of the femur performed with use of a trochanteric and a piriformis fossa entry portal.

Methods

110 patients with a femoral shaft fracture were enrolled in a prospective, randomized study.
54 patients were randomized to Group A (piriformis fossa portal) and 56 to Group B (trochanteric portal).
Outcome measures included the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index hip function score, pain, and blinded functional evaluation by a physical therapist.

Results

Most measures of hip function did not differ between the 2 groups.
The WOMAC score at 3, 6, and 12 months did not differ significantly between the piriformis fossa and trochanteric nailing groups.
Functional tests included the chair stand test and the timed up and go test.
Patients in Group B had significantly better scores on the chair stand test (13.3 compared with 11.1 in Group A, p = 0.04) at 6 months postoperatively, but there was no difference at 12 months (14.0 compared with 13.6).
The 2 groups did not differ significantly on the timed up and go test at either 6 or 12 months.
The 2 groups also did not differ on the muscle strength testing.
Intraoperative parameters differed significantly between the groups with respect to operative time, fluoroscopy time, and incision length, with the difference favoring Group B for each parameter.
Analog pain scale values were similar in Group A (2.49) and Group B (2.15) at 12 months postoperatively.

Conclusions

Patients in our prospective randomized study who were treated with trochanteric nailing did not differ in hip function at one year postoperatively compared with patients treated with intramedullary nailing through the piriformis fossa. The values of several intraoperative parameters were significantly better in the trochanteric nailing group. Our data indicate that the functional hip outcome of femoral intramedullary nailing performed through the greater trochanter is equal to that of intramedullary nailing performed through the piriformis fossa.

Supplemental

Functional Outcome Following Intramedullary Nailing of the Femur: A Prospective Randomized Comparison of Piriformis Fossa and Greater Trochanteric Entry Portals.

Stannard, Volgas, et al.J Bone Joint Surg Am201148 citationsRCT