A clinical study of management of supracondylar femur fracture with retrograde nailing

Abstract

Introduction: Supracondylar femur fractures are fractures that involve the distal 15cm of the femur. Because of the proximity of these fractures to the knee joint, regaining full knee motion may be difficult. Earlier a nonsurgical approach was used. Later in 1970s to early 1990s open reduction and internal fixation by means of plate and screw osteosynthesis, has emerged. Later Flexible intramedullary nailing, modified antegrade nailing, allowed fracture fixation with minimal exposure of the fracture site. However, axial and rotational stability of these implants are inferior. To counter these problems, retrograde supracondylar nailing was developed for stable interlocked nailing. The advantages of the supracondylar nail include a reduction in operating time and blood loss with reduction of devascularization of fracture fragments. Aim of the Study:The present study is undertaken to evaluate and explore supracondylar nailing in supracondylar fractures of femur with emphasis on a stable fixation with minimal exposure, early mobilization, less complications and a better quality of life. Materials and Methods: The present study was conducted in the department of orthopaedics at Alluri Sitarama Raju academy of medical sciences Hospital, Eluru, September 2016 and January 2019 (over a period of 28 months). 33 adult patients with supracondylar Fracture Femur were selected for the present study. Results: All fractures had a good clinical and radiological union. The fractures were stabilized with retrograde nailing in this series, the majority of the patients with distal femur fractures were due to road or automobile accidents upto the extent of 54.6%. The operative time for 42.4% of cases is 1 to 1and1/2 hr. Functional evaluation was done using Sanders 40 point functional evaluation scale. At the end of study, 87.9% cases had good to excellent results and 12.1% cases had fair results and no patient had poor results. Conclusion:From this study, it is concluded that, supracondylar nail is the optimal tool for many supracondylar fractures of femur. It provides rigid fixation, with significantly less periosteal stripping and soft tissue exposure than that of lateral fixation devices.