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Functional Outcome Following Intramedullary Nailing of the FemurA Prospective Randomized Comparison of Piriformis Fossa and Greater Trochanteric Entry Portals
James P. Stannard, MD1; Larry Bankston, MD2; Lydia A. Futch, PT, DSc, ATC3; Gerald McGwin, PhD4; David A. Volgas, MD1
1 Department of Orthopaedics, University of Missouri, One Hospital Drive, MC213, DC053.00, Columbia, MO 65212. E-mail address for J.P. Stannard: StannardJ@health.missouri.edu
2 Baton Rouge Orthopedic Clinic, 8080 Bluebonnet Boulevard, Suite 1000, Baton Rouge, LA 70810
3 University of Alabama at Birmingham Sports Medicine, 1600 7th Avenue South, ACC Suite 402, Birmingham, AL 35233
4 University of Alabama at Birmingham, 510 South 20th Street, FOT 960, Birmingham, AL 35294-3409
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the University of Alabama at Birmingham, Birmingham, Alabama

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Aug 03;93(15):1385-1391. doi: 10.2106/JBJS.J.00760
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Abstract

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: 

One hundred and ten patients with a femoral shaft fracture were enrolled in a prospective, randomized study. Fifty-four patients were randomized to Group A (piriformis fossa portal) and fifty-six 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 two groups. The WOMAC score at three, six, and twelve 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 six months postoperatively, but there was no difference at twelve months (14.0 compared with 13.6). The two groups did not differ significantly on the timed up and go test at either six or twelve months. The two 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 twelve 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.

Level of Evidence: 

Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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