Early data suggest equal function, less OR time with trochanteric vs. piriformis nailing

Researchers found no significant difference in abductor strength at 1 year, although trochanteric nailing yielded better hip function.

PHOENIX — Trochanteric nailing may produce better intraoperative results as well as postoperative function that is at least comparable to piriformis nailing, early findings from a prospective study suggest.

Researchers at the University of Alabama in Tuscaloosa, Ala., randomly assigned 108 patients with femoral fractures to one of two treatment groups. The first group included 53 fractures treated with piriformis nailing. The second group included 59 fractures treated with trochanteric nailing.

Radiologists blinded to the treatment performed functional evaluations at 6 and 12 months postoperatively, according to Larry Bankston, MD, a resident at the university and one of the study authors. He presented the results at the Orthopaedic Trauma Association 22nd Annual Meeting, here.

Trochanteric nailing produced intraoperative outcomes superior to piriformis nailing, Bankston said. In particular, trochanteric nailing resulted in significantly less blood loss and smaller incisions (P<.0001). It also significantly reduced operative time by about 30 minutes (P<.0001) as well as time using fluoroscopy (P=.0005), he noted.

"Overall, there is no statistically significant difference in regards to abductor strength at 6 and 12 months, but stronger hip function scores were seen in [trochanteric nailing] patients," Bankston said.

On a chair stand test, patients treated with trochanteric nailing performed slightly more reps over 30 seconds than patients treated with piriformis nailing, although the difference was not significant (P=.07).

The researchers also found similar results between groups in timed up & go tests, although patients treated with trochanteric nailing performed slightly faster at 6 and 12 months postop. Additionally, both groups had similar WOMAC scores at 3 and 6 months follow-up, although patients treated with trochanteric nailing had slightly better pain scores, according to the study.

"Without question, the trochanteric entry point is significantly easier and associated with shorter [operating] time, smaller incisions, less blood loss and ... [less time] with [fluoroscopy]," Bankston said. "In addition, this is our preliminary data showing that we have at least equivalent hip function between [both] groups ... with some trends toward [trochanteric nailing] patients."

For more information:
Stannard JP, Bankston L, Futch LA, et al. Functional outcomes following intramedullary nailing of the femur: a prospective randomized comparison of piriformis versus trochanteric nailing. Paper #9. Presented at the Orthopaedic Trauma Association 22nd Annual Meeting. Oct. 4-7, 2006. Phoenix.