• Prasoon Kumar, Deepak Neradi, Rohit Kansal, Sameer Aggarwal, Vishal Kumar, and Mandeep Singh Dhillon.
• Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India. Electronic address: drprasoonksingh@gmail.com.
• Injury. 2019 Oct 1; 50 (10): 1715-1724.

BackgroundIntramedullary nailing is the treatment of choice for shaft of femur fractures in adults. Antegrade nails involve entry through either piriformis fossa (PE) or greater trochanteric (GT) tip. The superiority of one entry point over the other is a matter of debate, and the present review was done to determine the same.Research QuestionIs GT entry for antegrade femur nailing superior to the PE for shaft femur fractures in adults?ObjectiveThe present systematic review was conducted to determine the superiority of one entry point over the other by comparing the outcome parameters like operative time, exposure to fluoroscopy, mal-unions, non unions, abductor weakness, varus malalignment and Harris Hip scores (HHS).MethodologyThree databases of PubMed, EMBASE and SCOPUS were searched for relevant articles that directly compared GT with PE for nailing in shaft femur fractures in adults.ResultsWe analysed a total of 9 studies published between the years 2011-2017. There were 5 retrospective and 4 prospective studies, out of which 3 were randomised. The total number of patients was 256 in GT group and 460 in PE group.OutcomesThere was significant superiority of GT entry over PE on meta analysis; lesser operation time: standard mean difference (SMD): -21.01; lesser exposure to fluoroscopy : SMD: 36.36; lesser incidence of abductor weakness: Odd's ratio (OR): 14.35; better functional outcome (HHS): SMD -2.48.ConclusionGT entry nails are superior to PE nails for treating shaft of femur fractures in adults. They have a shorter learning curve and better functional outcomes, however the rates of union are comparable in both.Copyright © 2019 Elsevier Ltd. All rights reserved.

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