Does using different entrance points for intramedullary nails affect clinical outcomes for femoral shaft fractures? A...

We examined the clinical and radiological outcomes of femoral shaft fractures treated with two different intramedullary nail designs using either greater trochanteric or trochanteric fossa entrance.

The medical records of patients undergoing operations for a shaft fracture either with a nail with trochanteric entrance or trochanteric fossa entrance were retrospectively reviewed. Inclusion criteria were: having the necessary medical records including radiographic images and follow-up data, at least 12 months of follow-up, skeletal maturity (≥16 years of age) not having osteoporosis (≤60 years of age). Exclusion criteria were: pathological fractures, fragility fractures, fractures that extend to hip or knee joint capsule, lack of enough medical data, less than 12 months of follow up, and patients yet to reach skeletal maturity.

A total of 65 patients (67 femur fractures) were treated with intramedullary nails using a trochanteric fossa entrance (TFE) and 21 patients (23 femur fractures) were treated with nails using a greater trochanteric entrance (GTE). No statistically significant differences were evident between groups in terms of union time, blood loss, need for implant removal, implant failure, or revision operation. However, the duration of postoperative hospitalization was significantly shorter in the GTE nail group and the need for open reduction of the fracture was less common in these patients. Although there were no significant differences between groups in terms of complications and union among isthmal and infra-isthmal fractures, malreduction and iatrogenic fractures were more common with the use of GTE nails for treatment of supra-isthmal fractures.

Use of intramedullary nails via both GTE and TFE were safe and efficient for the treatment of isthmal and infra-isthmal fractures. However, varus malalignments associated with iatrogenic fractures were more common with trochanteric entrance nails. Together, our results show that the use of nails via TFE may represent a safer option for surgical treatment of supra-isthmal fractures.