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Thursday, March 16, 2000

Percutaneous femoral nailing found safe, effective

Percutaneous femoral nailing is a safe and effective alternative to the standard technique, say researchers in a study in poster exhibit 437. They are reporting preliminary experience with a true percutaneous technique of antegrade femoral nailing.

There were 51 consecutive patients treated by one surgeon who began treating femoral fractures percutaneously in February 1997. All cases were performed in the lateral patient positioning with "reamed to fit", statically locked nails. Postoperative protocol allowed partial weight bearing and physiotherapy for gait training and motion.

The researchers recorded demographic data, procedure time, blood loss, complications, healing, knee motion, scar length and associated injuries and co-morbidities. They also compared the average length of stay of patients with isolated femur fractures treated with the percutaneous technique to a similar group of patients with isolated femur fractures treated with the standard incision.

There were 53 fractures in 51 patients (31 males and 20 females) with a mean age of 37.5 years (15-92 years). Mean follow up was 10 months (3-17 months). There were four open fractures (two Grade 1, one Grade 2 and one Grade 3). All fractures except one were healed by 24 weeks. This patient went on to union after bone grafting. There was no functional loss of knee motion. The blood loss was minimal and usually could not be measured.

Operative time averaged 74 minutes (34 to 90 minutes). For the entire group, scar length averaged 21 mm (11-35 mm). From February 1997 to July 1997, when the technique was being refined, the mean scar length tended to be longer with the last 40 patients having a scar averaging 16 mm.

There was one deep venous thrombosis, one fracture-site hematoma, one pulmonary embolus, one fracture of a distal interlocking screw and one cut out of the distal nail.

The median length of postoperative hospital stay for patients with isolated femur fractures treated percutaneously averaged three days, compared with four days for isolated femur fractures treated with the standard incision.

The researchers said there were no complications inherent to the technique itself. They observed that all patients, especially females, were very happy with the cosmetic result and described little to no pain around the entry site.

Co-authors of the study, both of University of Pittsburgh Medical Center, are Bruce H. Ziran, MD, assistant professor, and Frank Shuler, MD; and Dan Zlotolow, MD.

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2000 Academy News March 16 Index B

Last modified 06/March/2000 by IS