Trochanteric Nail Insertion for the Treatment of Femoral

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Trochanteric Nail Insertion for the Treatment of Femoral Shaft Fractures Journal of Orthopedic Trauma

Trochanteric Nail Insertion for the Treatment of Femoral Shaft Fractures Journal of Orthopedic Trauma vol. 19, 8, Sep. 2005 DR. ABDULRAHMAN ALGARNI

Introduction 1940, Kuntscher : tip of greater trochanter. 940, Bohler: ridge of greater Winquist

Introduction 1940, Kuntscher : tip of greater trochanter. 940, Bohler: ridge of greater Winquist : lateral to GT.

ignment. centric reaming of medial cortex of gment. ution at fracture site or both.

ignment. centric reaming of medial cortex of gment. ution at fracture site or both. piriformis ; obese).

Objective Using a nail especially designed for insertion ough G. T (TAN) could eliminate

Objective Using a nail especially designed for insertion ough G. T (TAN) could eliminate ils.

Materials and Methods Design and sitting : prospective; 3 trauma s; 1 of 4

Materials and Methods Design and sitting : prospective; 3 trauma s; 1 of 4 fellows. n. 1 , 1999 and Dec. 31 , 2000. 1 patients (14 – 97 yrs ) average (43. 6). 50 closed ; 11 open 5(1) , 2(3 A) , 2(3 B). 11 obese (113 – 159 kg) ; 3 > 181 kg.

supine ; TAN(cannulated, interlocking, Tit. ). 13 mm ; 7 cm ; 4 valgus

supine ; TAN(cannulated, interlocking, Tit. ). 13 mm ; 7 cm ; 4 valgus bend. Tip of GT, nail rotated 90 ; avoid iatrogenic ons. 2 reamed , 9 unreamed. All locked oximally and all but 4 distally.

Results Main outcome measures : union , alignment, complications and hip function. 4 Pts

Results Main outcome measures : union , alignment, complications and hip function. 4 Pts died ; 46 of 57 Pts (81%) for FU at a f 12 months.

Union Clinical and radiographic, all but 1 at 13 weeks , 1 dynamisation at

Union Clinical and radiographic, all but 1 at 13 weeks , 1 dynamisation at 12 wks and united at 22 wks. PT : once start WB.

Alignment Angulation(>10% in any plane or rotation>10) e; 1 Pt shortening of 2 cm.

Alignment Angulation(>10% in any plane or rotation>10) e; 1 Pt shortening of 2 cm.

Complications o iatrogenic fractures or infections. erotopic ossification : 5 hips. : mild (6)

Complications o iatrogenic fractures or infections. erotopic ossification : 5 hips. : mild (6) , moderate (2).

Hip Function 24 Pts : Harris Hip Score 77 (45 – 96). Hip ROM

Hip Function 24 Pts : Harris Hip Score 77 (45 – 96). Hip ROM : similar to normal side. Visual & video taped gait analysis : 3 Trend.

Discussion -Kuntscher : lateral; tip of GT; infection, AVN femoral head and neck fractures.

Discussion -Kuntscher : lateral; tip of GT; infection, AVN femoral head and neck fractures. op of GT. -AO : lateral to avoid damage to retinacular s and hip joint. -Straight nails through GT : comminution; rus esp. proximal fractures.

-Winquist : lateral ; switch to piriformis fossa -Johanson : >6 mm anterior to

-Winquist : lateral ; switch to piriformis fossa -Johanson : >6 mm anterior to PF; increase risk of complications ; position evolved to Mc fee and Waddle : morbidly obese ; difficult in supine using PF; increased risk of complications; accept more lateral starting

Ostrum : trochantric starting point; supine; atisfactory results in obese Pts. this study; esp.

Ostrum : trochantric starting point; supine; atisfactory results in obese Pts. this study; esp. nail and tip of GT. -Marks et al : 21% risk of HO using PF; 15% in -Gait and abductor weakness : comparable to PF

Conclusion Antegrade femoral nailing in supine position using pecially designed nail inserted through tip

Conclusion Antegrade femoral nailing in supine position using pecially designed nail inserted through tip of greater trochanter provides high union rate and low rate of complications including comminution and

Thank you

Thank you