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Entry Point Related Outcome in Antegrade Femoral Nailing: Experimental and clinical studies

C. Ansari

Entry point for antegrade nailing of the femur has been subject for discussion since the advent of Küntscher’s nail. He recommended the greater trochanter tip entry for his semi-rigid nail system. Later, the entry point was shifted to central, at the trochanteric fossa (piriform fossa), in order for a straight and rigid intramedullary nail to be inserted in line of the femoral canal. In the clinical situation however, the functional outcome after full rehabilitation remains suboptimal after treatment with a straight nail through the trochanteric fossa; with permanent residual pain, loss of endurance and some limping. In this dissertation the qualities of different entry points are tested in experimental and clinical settings and outlined in 9 chapters. In cadaveric studies the risk and soft tissue damage at operation and mechanical properties in terms of cortical bone strains are put into test. In-depth functional outcome is dealt with in clinical studies. Special attention is given to muscle strength and neurovascular status. Chapter 8 discusses the advantages and drawbacks of each entry point. Chapter 9 provides a summary both in English and Dutch.


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