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Antegrade piriformis entry femoral nailing
83%
978/1173
Antegrade greater trochanteric entry femoral nailing
7%
85/1173
Retrograde femoral nailing
1%
11/1173
External fixation of a femoral shaft fracture
7/1173
Open reduction and internal fixation of an intertrochanteric fracture
87/1173
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There is an increased rate of injury to the piriformis tendon, medial femoral circumflex artery branches, gluteus minimus, and superior gluteal nerve branches are noted with the piriformis starting site. Increased injury to the gluteus medius is seen with a greater trochanteric starting point. The referenced study by Dora et al noted increased injury to the piriformis tendon with a piriformis starting point (as compared to a more lateral insertion site). The classic referenced article by Johnson et al notes that anterior placement of the starting point >6mm over the recommended start leads to increased hoop stresses and possible burst-type fractures. The classic referenced study by Winquist et al reviewed their series of 520 femur fractures treated by antegrade nailing; they report a 99.1% union rate.
3.9
(18)
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