• Nasir Hussain, Farrah Naz Hussain, Corey Sermer, Hera Kamdar, Emil H Schemitsch, Amir Sternheim, and Paul Kuzyk.
• From the Department of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ont. (Hussain, Naz Hussain, Schemitsch); the Wayne State University School of Medicine, Detroit, Michigan (Naz Hussain); the Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Sermer, Sternheim, Kuzyk); and the Dow University of Health Sciences, Karachi, Pakistan (Kamdar).
• Can J Surg. 2017 Feb 1; 60 (1): 19-29.

BackgroundThere are several different techniques commonly used to perform intramedullary (IM) nailing of the femur to fix femoral fractures. We sought to identify significant differences in outcomes of studies comparing 1) trochanteric and piriformis entry and 2) antegrade and retrograde entry in IM nailing of the femur.MethodsWe searched MEDLINE, Cochrane and Embase databases and the Orthopaedic Trauma Association and American Academy of Orthopaedic Surgeons websites for comparative studies published from inception to November 2015. Criteria used to select articles for detailed review included use of antegrade and retrograde entry point or use of trochanteric and piriformis entry point for IM nailing of the femur in adult patients. Functional and technical outcomes were extracted from accepted studies.ResultsWe identified 483 potential studies, of which 52 were eligible. Of these, we included 13 publications and 2 abstracts (2 level I, 7 level II and 6 level III studies). Trochanteric entry significantly reduced operative duration by 14 min compared with piriformis entry (p = 0.030). Retrograde nailing had a greater risk of postoperative knee pain than antegrade nailing (p = 0.05). On the other hand, antegrade nailing had significantly more postoperative hip pain (p = 0.003) and heterotopic ossification (p < 0.001) than retrograde nailing. No significant differences in functional outcomes were observed.ConclusionAlthough some significant differences were found, the varying quality of studies made recommendation difficult. Our meta-analysis did not confirm superiority of either antegrade over retrograde or trochanteric over piriformis entry for IM nailing of the femur.Level Of EvidenceLevel III therapeutic.

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