Comminuted Refracture of the Distal Femur and Condyles in Patients with an Intramedullary Nail: A Report of 5 Cases

Abstract

Patients with in situ intramedullary nails sustaining a second distal femoral fracture following high-velocity trauma are infrequently reported in the literature. We report 5 such patients who sustained a second injury after 6 to 24 months, resulting in another fracture at the nail-tip level. These second fractures severely comminuted the femoral condyles. These patients required removal of the intramedullary nail, reconstruction of the comminuted femoral condyles, and stabilisation using an angled or buttress plate. Four of the 5 patients were followed up for a mean period of 36 months and were evaluated for knee status and outcome using Judet's criteria. Postoperative knee stiffness was common, and further interventions such as manipulation, hardware removal, arthrolysis, and quadricepsplasty were needed. One patient was lost to follow-up. The final results of the knees were good, with more than 100 degrees range of movement. It is important to adhere to established internal fixation protocols in the treatment of these complex nail tip fractures.

Refrakturen nach Entfernung von Osteosynthesematerialien

“…Am distalen Femur wurde nach Plattenentfernung sogar Refrakturraten von 27% beschrieben [5,12]. Von Sen et al [21] wird die Materialentfernung intramedullärer Femurnägel empfohlen, da er bei einliegendem Nagel und erneutem Unfall in 5 Fällen eine Distalisierung der Fraktur und deutlich kompliziertere Frakturtypen feststellte als ohne einliegenden Nagel. [14] und eine verzögerte Auffüllung der residuellen schraubenassoziierten Knochendefekte in der " single photon absorptiometry" [14,15,16,17].…”

Bent Intramedullary Femoral Nail: Surgical Technique of Removal and Reconstruction

“…Less comminution of fractures is observed when the intramedullary nail bends, absorbing much of the energy of the trauma. Also more energy is required to cause a refracture and bending of an intramedullary nail in completely healed fractures than in incompletely healed [5]. …”

“…Reviewing the available literature reveals that each case of distorted intramedullary nail removal was approached uniquely [1–5]. Technical support played a vital role in the method used to removal the nail with the least amount of damage to bone and soft tissue.…”

Modifizierte Technik zur Entfernung von Oberschenkelnägeln

“…Zusätzlich ist zu bedenken, dass einliegende massive Implantate diagnostische oder therapeutische Maßnahmen, die unfallunabhängig notwendig sind, erschweren oder unmöglich machen können [9,10]. Gerade bei jungen, aktiven Patienten können auch spätere, implantatnahe Sportverletzungen eine Herausforderung darstellen [10,15] Interessenkonflikt: Nein…”