Comparison of Knee Function After Antegrade and Retrograde Intramedullary Nailing for Diaphyseal Femoral Fractures: Results of Isokinetic Evaluation

Abstract

Knee function seems to have similar clinical results after either antegrade or retrograde nail insertion for femoral diaphyseal fractures when knee range of motion, Lysholm Scores, and isokinetic knee evaluation are considered as outcome measures. With increasing patient age, a decrease in knee functioning should be anticipated in patients with femoral fractures treated with intramedullary nails regardless of technique.

Femoral malrotation from diaphyseal fractures results in changes in patellofemoral alignment and higher patellofemoral stress from a finite element model study

“…Fracture of the femoral shaft is classically managed by antegrade intramedullary nailing as the standard treatment. Good results are reported due to early weight-bearing conditions and joint physiotherapy [1][2][3][4][5][6]. However femoral malrotation of more than ten degrees ranges until 40% in clinical series [2,5].…”

Analysis of Retrograde Femoral Intramedullary Nail Placement Through Traumatic Knee Arthrotomies

“…9,10 However, clinical studies have found no difference in knee range of motion and function following either approach (antegrade vs. retrograde). 7 Additionally, retrograde nailing of open femoral fractures had a presumed increased risk of knee sepsis, until recently when O'Toole et al 11 found the infection rate in this situation to be 1.1%.…”

“…2,4-6 Many potential problems in the knee were thought to be associated with retrograde femoral nail placement, including articular cartilage damage, cruciate ligament disruption, knee sepsis, stiffness, patellofemoral degeneration, and quadriceps atrophy. 7,8 Because of these potential problems, controversy existed concerning the effects on postoperative knee function after retrograde nailing, even causing an extra-articular retrograde nail insertion technique to be used for a brief time. 9,10 However, clinical studies have found no difference in knee range of motion and function following either approach (antegrade vs. retrograde).…”

Lengthening Over a Retrograde Nail Using 3 Schanz Pins

“…6 Retrograde nail insertion does not seem to have a detrimental effect on knee function and does not increase the risk for knee sepsis. 7,8 During external fixator application in the femur, most problems occur around the proximal pins because of the bulky soft tissues. To decrease pin site problems, we prefer retrograde nailing, which allows the use of a single Schanz pin at the proximal thigh.…”