title: Functional outcome after antegrade femoral nailing: a comparison of trochanteric fossa versus tip of greater trochanter entry point.
abstract: OBJECTIVE
  This study was performed to explore the relationship between entry point-related soft tissue damage in antegrade femoral nailing and the functional outcome in patients with a proximal third femoral shaft fracture.
  
  
  METHODS
  Retrospective clinical trial.
  
  
  METHODS
  Level I university trauma center.
  
  
  METHODS
  Seventeen patients with a high femoral shaft fracture treated with an antegrade femoral nail joined the study.
  
  
  METHODS
  Nine patients with an Unreamed Femoral Nail (UFN; Synthes, Bettlach, Switzerland) inserted at the trochanteric fossa and eight patients with a long Proximal Femoral Nail (PFN; Synthes) inserted at the tip of the greater trochanter.
  
  
  METHODS
  Pain, gait, nerve, and muscle function along with endurance.
  
  
  RESULTS
  Five patients with a UFN had a positive Trendelenburg sign and a reinnervated superior gluteal nerve after initial injury of the nerve at operation. None of these findings occurred in the long PFN group (P = 0.01). Isokinetic measurements showed diminished abduction as well as external rotator function in the UFN group rather than in the long PFN group. Leg endurance was significantly lower in patients with a UFN.
  
  
  CONCLUSIONS
  Compared with the trochanteric fossa, femoral nailing through the greater trochanter tip may decrease the risk of damage to the superior gluteal nerve and intraoperative damage to the muscular apparatus of the hip region, resulting in some improved muscle function. Therefore, a lateral entry point may be a rational alternative for conventional nailing through the trochanteric fossa.
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Chloe
authors.initials: C
authors.lastname: Ansari Moein
authors.forename: Henk-Jan
authors.initials: HJ
authors.lastname: ten Duis
authors.forename: Liam
authors.initials: L
authors.lastname: Oey
authors.forename: Gerard
authors.initials: G
authors.lastname: de Kort
authors.forename: Wout
authors.initials: W
authors.lastname: van der Meulen
authors.forename: Karin
authors.initials: K
authors.lastname: Vermeulen
authors.forename: Christiaan
authors.initials: C
authors.lastname: van der Werken
mesh_terms: D000293:Adolescent; D000328:Adult; D001858:Bone Nails; D005260:Female; D005269:Femur / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D016896:Treatment Outcome