Venting during prophylactic nailing for femoral XXXX : current orthopedic practice.

@entity887 @entity3 @entity3330 @entity174
INTRODUCTION: Reamed intramedullary nailing, recommended for impending @entity174 of a femur weakened by bone @entity3 , causes a rise in intramedullary pressure and increases the risk of a fat @entity887 . The pressure can be equalized by the technique of venting--drilling a hole into the distal cortex of the femur. Our objective was to study the current practice of orthopedic surgeons in Ontario with respect to venting during prophylactic intramedullary nailing for an impending @entity3330 due to bone @entity3 . METHODS: We mailed a questionnaire to all orthopedic surgeons from the Province of Ontario listed in the 1999 Canadian Medical Directory or on the Canadian Orthopaedic Association membership list, asking if they vent when prophylactically nailing an impending pathologic @entity3330 . The responses were modelled as a function of surgeon volume and year of graduation. RESULTS: Of the 415 surveys mailed, 223 (54%) surgeons responded. Of these, 81% reported having prophylactically treated a femoral metastatic lesion during the previous year; 67% treated 1 to 3 metastatic lesions and 14% treated more than 3; 19% did not treat a metastatic femoral lesion prophylactically. Over two-thirds of surgeons had never considered venting, whereas one-third always or sometimes vented the femoral canal. More recent graduates were 3 times more likely to vent than earlier (before 1980) graduates (odds ratio [OR] = 3.2, 95% confidence interval [CI] 1.6-6.5) as were those who treat a greater number of impending @entity174 (OR = 1.4, 95% CI 1.1-1.7). CONCLUSIONS: Although there is a theoretical rationale for routine venting, there is disagreement among Ontario orthopedic surgeons regarding the use of this technique during prophylactic nailing for femoral metastatic lesions. Prospective evidence will be required to warrant a change in the standard of care.
