Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip

Moein, C.M. Ansari; Verhofstad, M.H.J.; Bleys, Ronald L. A. W.; Werken, Chr. van der

doi:10.1016/j.injury.2004.07.052

Cited by 93 publications

(26 citation statements)

References 14 publications

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“…9 Cephalomedullary femoral reconstruction nails with a trochanteric entry point are biomechanically stronger than extramedullary implants. 10 In unstable proximal femoral fractures, control of axial telescoping and rotational stability are essential. Intramedullary implants inserted in a less-invasive manner are better tolerated by the elderly.…”

Section: Discussionmentioning

confidence: 99%

Proximal femoral nail- outcome and complications: a prospective study of 125 cases of proximal femoral fractures

et al. 2017

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Background: Fractures of the proximal femur are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Fractures of the proximal femur include trochantric and subtrochantric fractures. The present study was designed to evaluate and analyze the role of proximal femoral nail (PFN) in the treatment of proximal femoral fractures.Methods: It was a prospective study on 125 cases of proximal femoral fractures. The fractures were classified according to AO classification. Salvati and Wilson Score were used for functional assessment.Results: In this study at 6 months follow up, union was achieved in 123 cases, open reduction was performed in 11% of cases (14 cases). Technical and mechanical complications were noted in 21% cases (27 cases). Reoperation rate was 4% (Five cases). According to Salvati and Wilson scoring system excellent results were seen in 36% of cases (45 cases), good results in 46% cases (58 cases), fair result in 13% cases (16 cases) and poor results in 5% cases (6 cases). Conclusions: It is concluded from our study that proximal femoral nailing is an attractive and suitable implant for Proximal Femoral Fractures and its use in unstable intertrochantric fractures is very encouraging.

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Section: Discussionmentioning

confidence: 99%

Proximal femoral nail- outcome and complications: a prospective study of 125 cases of proximal femoral fractures

et al. 2017

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“…14 Cephalomedullary femoral reconstruction nails with a trochanteric entry point are biomechanically stronger than extramedullary implants. 15 In unstable proximal femoral fractures, control of axial telescoping and rotational stability are essential. Intramedullary implants inserted in a less-invasive manner are better tolerated by the elderly.…”

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confidence: 99%

Short Proximal Femoral Nail Fixation for Trochanteric Fractures

Gadegone

Salphale

2010

J Orthop Surg (Hong Kong)

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Purpose. To review outcomes of 100 patients who underwent short proximal femoral nailing for stable and unstable intertrochanteric fractures. Methods. Records of 62 men and 38 women aged 56 to 83 (mean, 67) years who underwent short proximal femoral nailing for stable peritrochanteric A1 (n=36), unstable peritrochanteric A2 (n=40), and unstable intertrochanteric A3 (n=24) fractures were reviewed. Results. 80 patients achieved anatomic reduction. At the one-year follow-up, 90% of the patients had good or excellent outcomes, and 50% had returned to their pre-injury functional level. One patient with avascular necrosis noted at 20 months and another patient with non-union/pseudarthrosis underwent a revision bipolar arthroplasty. Two patients had a Z effect and one a reverse Z effect. Six patients with osteoporosis had superior migration of the nail with varus collapse. Two patients had cutting out of the screw, but the fractures eventually healed. Ten patients had shortening of <2 cm. Seven patients had lateral thigh discomfort attributed to irritation Short proximal femoral nail fixation for trochanteric fractures Wasudeo M Gadegone, Yogesh S SalphaleDepartment of Orthopaedics and Traumatology, Chandrapur Multispeciality Hospital, Chandrapur, India Address correspondence and reprint requests to: Dr Yogesh S Salphale, "Shushrusha", Opp. Z.P., Chandrapur, 442401, India. E-mail: yogeshsalphale@gmail.com Surgery 2010;18(1):39-44 2010;18(1):39-44 of the protruding screws against the tensor fascia lata, and 5 of them underwent screw removal. None had fractures of the femoral shaft or trochanter or experienced nail breakage. Conclusion. The short proximal femoral nail is a superior implant for stable and unstable intertrochanteric fractures in terms of operating time, surgical exposure, blood loss, and complications, especially for patients with relatively small femora. Journal of Orthopaedic

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“…Using a lateral entry point such as the tip of the greater trochanter with an appropriate nail design may avoid these complications. Our former study (Moein et al, 2005) showed the actual injury of the neurovascular and musculotendineal apparatus sustained during the blind insertion procedure through both entry points. In this study we explored the topographical relationships of various soft tissue structures to the trochanteric fossa and the tip of the greater trochanter and compared the safety of the two different entry points regarding the adjacent soft tissues, regardless of the capacities of the surgeon or random soft tissue injury due to the blindness of the procedure.…”

Section: Discussionmentioning

confidence: 96%

“…Persistent pain at the trochanteric region, the proximal thigh and in the scar area, interfering with lifestyle or mobility after nailing, has also been reported (Danckwardt-Lilliestrom and Sjogren, 1976;Dodenhoff et al, 1997) as well as loss of abduction strength of the hip (Jacobs and Buxton, 1989;Bain et al, 1997). Percutaneous nail insertion involves blind dissection through the gluteal muscles on the approach to the entry point and thus multiple neurovascular and musculotendineous structures are at risk, especially when they are not directly exposed in the operation field (Moein et al, 2005). Opening the medullary canal through the trochanteric fossa not only involves injury of the gluteal musculature but also jeopardizes tendons of the hip external rotators as well such as the obturator externus, gemelli, and obturator internus muscles.…”

Section: Introductionmentioning

confidence: 99%

Soft tissue anatomy around the hip and its implications for choice of entry point in antegrade femoral nailing

et al. 2008

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Antegrade intramedullary nailing is an accepted method of treatment for femoral shaft fractures. Entrance of the nail through the trochanteric fossa is currently recommended by some surgeons. This approach results in some cases, however, in loss of abduction strength and persistent pain. Nail insertion at the tip of the greater trochanter may be more favorable. In this study the anatomical relationships of the trochanteric fossa and of the tip of the greater trochanter were explored. Dissection was carried out in 10 fresh human cadaver femurs. The risks and safety of the two entry points with respect to the adjacent soft tissues were assessed. Abductor muscles and tendons, branches of the medial circumflex femoral artery and the hip joint capsule were at risk during nail insertion through the trochanteric fossa. These structures were not endangered during insertion through the trochanteric tip. The reported clinical morbidity after nailing through the trochanteric fossa may result from direct soft tissue injury and may be reduced by choosing the route through the greater trochanter.

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Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip

Cited by 93 publications

References 14 publications

Proximal femoral nail- outcome and complications: a prospective study of 125 cases of proximal femoral fractures

Proximal femoral nail- outcome and complications: a prospective study of 125 cases of proximal femoral fractures

Short Proximal Femoral Nail Fixation for Trochanteric Fractures

Soft tissue anatomy around the hip and its implications for choice of entry point in antegrade femoral nailing

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