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Erschienen in:
01.09.2015 | Original Article
Percutaneous versus conventional approach for antegrade femoral nailing, which technique should be the standard one?
Erschienen in: European Orthopaedics and Traumatology | Ausgabe 3/2015
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Background
The standard (conventional) approach (CA) for antegrade femoral nailing was accused for many functional and cosmetic complications, while the minimal reports about the percutaneous approach (PA) revealed better results. The purpose of this study was to compare prospectively both approaches trying to determine which technique should be the standard one.
Patients and methods
Between February 2007 and January 2010, 206 patients admitted to emergency department with 212 femoral shaft fractures were blindly randomized into either technique with a ratio 1:1. All the patients were treated by reamed statically locked nailing and were followed up for 2 years. All the operative and postoperative variables were compared. The Harris hip score was used for functional assessment.
Results
Eleven patients with 12 fractures were excluded, and 103 femur fractures in the CA group were compared to 97 fractures in the PA group. The mean operating time, blood loss, incision scar length, and hospital stay were significantly increased in the CA group. The number of patients was significantly larger in the CA group in relation to incidence of hip pain, reduced range of hip abduction, presence of a limp, and occurrence of heterotopic ossification. The number of physiotherapy treatments was significantly less in the PA group. The mean time for return to work was significantly longer in the CA group. The mean Harris hip score was significantly lower in the CA group.
Conclusions
Many advantages, surgical, cosmetic, functional, and economic, were encountered for the PA. We announced the PA to be the standard approach for antegrade femoral nailing at the authors’ institutes. An international multicenter randomized comparative study is recommended.