Treatment of the Femoral Fracture Using Sirus(R) Nail: A Comparison of Complication according to the Entry Potal

PURPOSE: The purpose of this study is to analyze the clinical results of fixation using Sirus(R) nail in patients with femoral subtrochanteric and shaft fracture and the difference in the frequency of complications according to the entry portal. MATERIALS AND METHODS: From July 2006 to August 2013, at least 1-year clinical follow-up, we retrospectively analyzed 36 cases with femoral subtrochanteric (15 cases) and shaft fracture (21 cases) who underwent surgery using Sirus(R) nail. We reviewed the records of operation time, intra-operative amounts of bleeding and complications. At last follow-up, we reviewed clinical results by Ray-Sanders criteria and analyzed the periods of bone union on the radiograph. We also measured changing of the femoral neck-shaft angle in the subtrochanteric fractures and angulation in the shaft fractures, respectively. Considering anatomical variation of the trochanter and fracture position of subtrochanteric and femoral shaft, entry points were divided into subgroups, and the clinical results were compared. RESULTS: The mean Ray-Sanders score was 27.4, 27 cases (75.0%) were good or excellent. The mean periods of bone union was 21.1 weeks in 31 cases. The mean neck-shaft angles were 135.7o preoperatively, 130.2o postoperatively. The mean angulation of the femur was 24.4o preoperatively, 2.4o postoperatively in patients of femoral shaft fractures. Despite no statistical significance, greater trochanter tip entry point and lateral entry point had a higher rate of frequency than medial entry point, with respect to the occurrence of iatrogenic fracture and malalignment. CONCLUSION: Using Sirus(R) nail for femoral subtrochanteric and shaft fractures showed good clinical and radiographic results and a high rate of union. Medial entry point yielded slightly better results in the occurrence of iatrogenic fracture and malalignment, compared to greater trochanter tip entry point and lateral entry point.

Results of Intramedullary Nailing of Femoral Shaft Fracture: Trochanteric Entry Portal (Sirus Nail) versus Piriformis Entry Portal (M/DN Nail)

PURPOSE: To compare treatment results obtained using the trochanteric (Sirus nail) entry portal with those obtained using the Piriformis fossa (M/DN) entry portal during intramedullary (IM) nailing of femur shaft fractures. MATERIALS AND METHODS: Four hundreds and thirty-two patients treated for femur shaft fracture using IM nails from February, 2001 to May, 2010 were divided into two groups. group 1 was composed of 180 patients treated through the trochanteric (Sirus nail; n=180) entry portal, while group 2 contained 170 patients treated through the piriformis fossa (M/DN nail; n=170) entry portal. We compared the clinical and radiographic findings of both groups to evaluate the treatment results. RESULTS: Functional result, range of motion and union time (18, 20 weeks) were similar in both groups. The operation time of patients in the over-weighted group was 90 minutes in group 1 and 120 minutes in group 2 (p0.05). There were 18 iatrogenic fractures in group 1 and 4 in group 2 (p<0.05). CONCLUSION: There was not much difference in complications based on clinical and radiographic findings of both groups. For groups using the trochanteric entry portal, the operation time was shorter and blood loss was lower than in groups using the piriformis entry portal. Iatrogenic fracture occurred more often in the group using the trochanteric entry portal than in the group using the piriformis entry portal.