Retrograde Nailing for Distal Third Femoral Shaft Fractures: A Prospective Study

Abstract

Purpose. To evaluate the postoperative knee function and results of unreamed retrograde nailing for distal third femoral shaft fractures. Methods. Between January 2002 and 2003 inclusive, a consecutive series of 27 patients (with 28 fractures) who underwent retrograde nailing were prospectively evaluated. Outcome measures were union time, initiation of weight bearing, deformity and shortening, functional length of the nail, knee function assessed using a modified Knee Society Knee Score. Correlations between union time and other variables were also studied. Results. In these patients 26 (93%) of the 28 fractures achieved union, of which 5 underwent dynamisation; the mean union time for the other 21 fractures was 4.4 months. Angular malalignment was present in 4 patients and shortening in 4 others. There was negligible correlation between union time and variables of nail-canal diameter mismatch, functional length of nail, fracture geometry, or initiation of partial weightRetrograde nailing for distal third femoral shaft fractures: a prospective study KN AcharyaDepartment of Orthopaedics, SDM College of Medical Sciences, Dharwad, Karnataka, India MR RaoDepartment of Orthopaedics, Jubilee Mission Hospital, Thrissur, Kerala, India Address correspondence and reprint requests to: Dr K Narayana Acharya, Meenakshi Nilaya, BMA Road, Gandhinagar, Bellary, 583103, Karnataka, India. E-mail: knacharya@hotmail.com 2006;14(3):253-8 bearing ambulation. Knee flexion of more than 100 degrees was achieved in 26 patients. 19 patients had anterior knee pain and 10 had instability. By the end of one year, excellent or good scores for pain and function were recorded in 77% and 73% respectively, of the 26 patients. Conclusion. In view of such favourable union rates but significant deterioration in overall knee joint function, at best retrograde nailing is a reliable alternative in the management of selected complicated fractures of the distal femoral shaft. Journal of Orthopaedic Surgery

Retrograde nailing of femoral fractures: a retrospective study

“…It has been reported as high as 70 % in one series [19]. In our study, it was present in 23 % of patients.…”

“…It is reported in the literature that injury to the knee is common in femoral shaft fractures, and that could be one of the causes of knee pain. The surgical technique and position of distal screws have been reported to be responsible for knee pain [19]. Placing appropriate length interlocking screws at the knee, and obtaining internal rotation oblique radiographs to confirm the length of the screw in view of the distal femur's rhomboid shape anatomy, would be of great help to prevent these patients from returning to OR for hardware removal due to screw prominence [27].…”

“…Acharya reports knee pain in up to 70 % of patients following a retrograde nail [19]. The objective of this retrospective study is to describe healing and complication rates in 31 patients who underwent retrograde intramedullary nailing done by a single orthopedic trauma fellowship-trained surgeon at VCU Medical Center.…”

Distal femoral fractures

“…Fracture fixation was predominantly with anatomical periarticular locking plates, and a smaller number of retrograde intramedullary nails. Whilst this reflects the current literature, with the role of locking plates expanding as the technology evolves [21], studies supporting both methods of fixation have been published [22][23][24][25][26][27][28][29][30][31][32]. However there still remains a paucity of longterm functional and radiological follow-up.…”

Current concept of management of supracondylar femur fracture: retrograde femoral nail or distal femoral locking plate

“…7 Strength under axial compression was better with the LCP system than with the blade plate or nailing, by 34 and 13% respectively, but strength under torsion was reduced. [8][9][10][11][12] The authors observed better distal fixation with the LCP system with loss of distal fixation in only one LCP plate (6%), three blade plates (38%) and eight losses with retrograde intramedullary nailing (100%).…”