Retrograde Intramedullary Interlocking Nailing in Fractures of the Distal Femur: A Review of 20 Cases with an Average Follow-Up of One Year

Abstract

Objectives: In patients with distal femur fractures, we studied the role of retrograde locked intramedullary nails. Methods: Retrograde locked intramedullary nailing was used to treat the distal femur fractures of 20 patients (15 males, 5 females; mean age 47 years; range 25 to 69 years). Two patients had fracture of the distal femur and shaft. The fractures were classified as A1 (n=12), A2 (n=6), A3 (n=2), by the AO classification. There were two Grade I open fractures and 18 closed fractures. Three fractures were managed with percutaneous technique. At the mean first follow-up time of 18 months (range 15-48 months and mean second follow up at 27 months (range 12 to 68 months), the concluding functional results were assessed by using the modified Hospital for Special Surgery (HSS) knee assessment scale. Results: The average time to achieve union was 24.2 weeks (range 14 to 42 weeks). One patient had a delayed union (44 weeks). Five knees (25%) had normal joint range of motion, ten knees (50%) were having range of motion from 100° to 110°, three knees (15%) were having range of motion of 80°, and two knees (10%) were having range of motion below the 80°. According to the modified HSS knee scale, the results were excellent in eleven cases (55%), good in six (30%), moderate in two (10%), and poor in one case (5%). In two patients (10%), the postoperative radiographic examination revealed varus angulation (10°), healing took place with severe distortion in one subject. None of the patient had any deep infection or wound issues. Conclusion: Retrograde femoral nailing is an effective method for treating distal femoral shaft fractures. The healing rate of femoral shaft fractures fixed with a retrograde nail is the same regardless of fracture location, patient age, gender, or degree of comminution. For good results surgical treatment, post-surgery immediate knee mobilisation and avoiding nail tip prominence in the knee are essential.