Bone and Joint Institute
Document Type
Article
Publication Date
2-1-2017
Journal
Canadian Journal of Surgery
Volume
60
Issue
1
First Page
19
Last Page
29
URL with Digital Object Identifier
10.1503/cjs.000616
Abstract
© 2017 Joule Inc. or its licensors. Background: There are several different techniques commonly used to perform intramedullary (IM) nailing of the femur to fix femoral fractures. We sought to identify significant differences in outcomes of studies comparing 1) trochanteric and piriformis entry and 2) antegrade and retrograde entry in IM nailing of the femur. Methods: We searched MEDLINE, Cochrane and Embase databases and the Orthopaedic Trauma Association and American Academy of Orthopaedic Surgeons websites for comparative studies published from inception to November 2015. Criteria used to select articles for detailed review included use of antegrade and retrograde entry point or use of trochanteric and piriformis entry point for IM nailing of the femur in adult patients. Functional and technical outcomes were extracted from accepted studies. Results: We identified 483 potential studies, of which 52 were eligible. Of these, we included 13 publications and 2 abstracts (2 level I, 7 level II and 6 level III studies). Trochanteric entry significantly reduced operative duration by 14 min compared with piriformis entry (p = 0.030). Retrograde nailing had a greater risk of postoperative knee pain than antegrade nailing (p = 0.05). On the other hand, antegrade nailing had significantly more postoperative hip pain (p = 0.003) and heterotopic ossification (p < 0.001) than retrograde nailing. No significant differences in functional outcomes were observed. Conclusion: Although some significant differences were found, the varying quality of studies made recommendation difficult. Our meta-Analysis did not confirm superiority of either antegrade over retrograde or trochanteric over piriformis entry for IM nailing of the femur. Level of evidence: Level III therapeutic.
Notes
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The article was originally published at
Hussain, N., Hussain, F. N., Sermer, C., Kamdar, H., Schemitsch, E. H., Sternheim, A., & Kuzyk, P. (2017). Antegrade versus retrograde nailing techniques and trochanteric versus piriformis intramedullary nailing entry points for femoral shaft fractures: a systematic review and meta-analysis. Canadian journal of surgery. Journal canadien de chirurgie, 60(1), 19–29. https://doi.org/10.1503/cjs.000616
Also found at http://canjsurg.ca/60-1-19/