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Level I study cites trochanteric nailing as an acceptable option to piriformis nailing

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DENVER — Trochanteric antegrade nailing of femoral fractures may lead to significantly better intraoperative results and a trend toward improved functional outcomes compared to pirformis nailing, according to a prospective randomized study presented here.

James P. Stannard, MD, and colleagues conducted a minimum 1-year follow-up of 110 patients with femoral fractures who were randomized to receive either pirformis or trochanteric antegrade nailing. The investigators collected intraoperative and radiographic outcomes, and a blinded licensed physical therapist evaluated the patients for function using timed-up-and-go, chair-stand and hip abduction strength tests.

Stannard presented the findings at the 24th Annual Meeting of the Orthopaedic Trauma Association, here.

The investigators discovered shorter incision length, operative time and fluoroscopy time and less estimated blood loss in patients in the trochanteric group compared to the pirformis group. All of the differences were statistically significant.

They also found similar results for radiographic and clinical union for the groups and discovered no significant differences between the cohorts regarding nonunions and delayed healing.

In addition, the study revealed a trend toward more heterotopic ossification (HO) in the pirformis group. Significantly more patients in the pirformis group had Grade III and IV HO compared to those in the trochanteric group. The groups also showed similar WOMAC scores at 6 and 12 months.

Although the investigators found no significant differences between the groups for timed-up-and-go and chair-stand testing, they saw a trend toward better results in the trochanteric group.

Strength testing revealed nearly identical results between the groups, with both cohorts showing improvements in gluteus medius and tensor fascia latae strength.

“[At] the very least, we do conclude that the trochanteric [starting point] is a very acceptable alternative, that there are some trends that may be better in terms of long-term outcome, and that it is somewhat easier,” Stannard said.

For more information:

• Stannard JP, Volgas DA, Bankson LS, et al. Paper #49. Piriformis versus trochanteric antegrade nailing of femoral fractures: A prospective randomized study. Presented at the 24th Annual Meeting of the Orthopaedic Trauma Association. Oct. 16-18, 2008. Denver.