Anatomic observation and clinical application of identifying the entry point in the greater trochanter for antegrade femoral intramedullary nailing without the fluoroscopic guidance
Li Yunfei, Gao Sheng, Zhang Qiuqin, Shen Baoliang
Department of Orthopaedic, the Central Hospital of Jiading District, Shanghai 21800, China
Abstract：Objective To identify the entry points for antegrade femoral nailing without the fluoroscopic guidance. Methods From December 2007 to June 2008, 8 cadavers (5 males, 3 females) wet adult hip specimens which were 10% formalin-fixed, were used for the observation of the morphological character of the greater trochanter apex, the region that the gluteal muscle and piriformis attached was marked and observed. The anatomical relationship between the greater trochanter crest notch point, the axis of the medullary cavity and piriformis fossa were observed. From January 2010 to November 2012, 44 consecutive patients with intertrochanteric or femur shaft fractures, including 20 males and 24 females; aged 25 to 85 years, mean (66.9 ± 15.7) years. All fractures were fixed with antegrade intramedullary nail. The intramedullary nail open position was determined by finger touch without fluoroscopy based the relationship between the greater trochanter crest notch point and piriformis fossa from the cadavers research. Results The greater trochanter near femoral neck portion was similar to the mountain crest-like "C" shaped structure outwardly form overlook in cadaver. The greater trochanter crest was a high posterior portion, flater and lower anterior portion, a depressed notch could be felt by finger in middle of two portions. Gluteus medius attached to the outer portion of the greater trochanter crest, piriformis tendon attached to the inner portion of the greater trochanter crest notch. Piriformis fossa was the bone cave that piriformis tendon attachment point recessed, piriformis fossa substantially in the intramedullary axis, just medial the trochanter crest notch on anteroposterior photographs. Only once fluoroscopy was used to check the entry portal tool direction in 44 patients, because the patient was not satisfied to determine the intramedullary axis of proximal fragment. The other patients were not used anymore fluorcscopy to check the guidewire insert the medullary cavity, and nail were inserted well. All patients were followed up from 9 to 28 months, average of 18.4 months. Except one case of femoral shaft fracture delayed union, fracture union after removing lock screw, the other patients healed well. No case had nail loosen and femoral head was cut out. Conclusions The greater trochanteric specious notch, instead of the piriformis fossa, may be a feasible choice to identify the entry points for antegrade femoral nailing. It can be used to treat the femoral shaft and subtrochanteric fractures without the fluoroscopic guidance just by finger touch. Which can avoid repeated fluoroscopy and reduce radiation damage.
李云飞,高生,张秋琴,沈宝良. 非透视下确定顺行股骨髓内钉大转子进钉点的解剖观察及临床应用[J]. 中华解剖与临床杂志, 2016, 21(3): 210-214.
Li Yunfei, Gao Sheng, Zhang Qiuqin, Shen Baoliang. Anatomic observation and clinical application of identifying the entry point in the greater trochanter for antegrade femoral intramedullary nailing without the fluoroscopic guidance. Chinese Journal of Anatomy and Clinics, 2016, 21(3): 210-214.
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2016, Vol. 21 
