Retrograde Nailing of the Femur. Our Clinical Experience

Abstract

During the period 1997-2000 45 patients with 49 fractures of the distal femur, were treated with retrograde intramedullary nail. 39 patients with 43 fractures were available for the final follow-up in a mean time of 19.3 months. 10 patients had periprosthetic fractures, 2 non-unions after previous failed fixation and 1 pathological fracture. Union was achieved in all the patients except one at 11.3 weeks average time. There were 2 malunions needed re-operation. From the rest of the patients there were 4 with an excellent, 16 with a good and 14 with a fair result. There was one superficial infection, treated conservatively. 5 interlocking screws in 3 patients were broken. Retrograde nailing of the distal femur appears as a reliable technique for supra-intraarticular and supracondylar fractures. However a prerequisite is a precise intraoperative reduction.

Key words

Supracondylar - Fracture - Periprosthetic

References

• 1 Butt M S, Krikler S J, Ali M. Displaced fractures of the distal femur in elderly patients: Operative versus non-operative treatment.  J Bone Joint Surg [Br]. 1996;  78 110-114
• 2 Dunlop D G, Brenkel I J. The supracondylar intramedullary nail in elderly patients with distal femoral fractures.  Injury. 1999;  30 (7) 475-484
• 3 EI Maraghy A W, Schenutch E H, Richards R R. Femoral and cruciate blood flow after retrograde femoral reaming: a canine study using laser Doppler fluometry.  J Orthop Trauma. 1998;  124 253-258
• 4 Gellman R E, Paiement G D, Green H D, Coughlin R R. Treatment of supracondylar femoral fractures with a retrograde intramedullary nail.  Clin Orthop. 1996;  Nov (332) 90-97
• 5 Henry S L, Trager S, Green S, Seligson D. Management of supracondylar fractures of the femur with the GSH supracondylar nail: Preliminary report.  Contemp Orthop. 1991;  22 631-640
• 6 Johnson E, Marroquin C, Kossovsky K. Synovial metallosis resulting from intraarticular intramedullary nailing of a distal femoral nonunion.  J Orthop Trauma. 1993;  7 320-324
• 7 Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults.  Acta Orthop Scand. 1982;  53 957-962
• 8 Kumar A, Jasani V, Butt M S. Management of distal femoral fractures in elderly patients using retrograde titanium supracondylar nails.  Injury. 2000;  31(3) 69-73
• 9 Lane J M, Cornell C N, Barth R. et al .Pathologic fractures, part II: metabolic bone diseases. In: Skeletal Trauma, ed. by Browner BD, Jupiter JB, Levine AM et al. Philadelphia. WS Saunders 1993: 534-554
• 10 Lucas S E, Seligson D, Henry S L. Intramedullary supracondylar nailing of femoral fractures.  Clin Orthop. 1993;  296 200-206
• 11 Moore T J, Watson T, Green S A, Garland D E, Chandler R W. Complications of surgically treated supracondylar fractures of the femur.  J Trauma. 1987;  27 402-406
• 12 Moran M C, Brick G W, Sledge C B, Dysart S H, Chien E P. Supracondylar femoral fracture following total knee arthroplasty.  Clin Orthop. 1996;  324 196-209
• 13 Naileth J, Koval K J, Seligson D, Rosen H, Fee K. Distal femoral nonunion: Treatment with a retrograde inserted locked intramedullary.  J Orthop Trauma. 1995;  9 285-291
• 14 Neer C S, Grantham S A, Shelton M L. Supracondylar fracture of the adult femur: A study of one hundred and ten cases.  J Bone Joint Surg [Am]. 1967;  49 591-613
• 15 Pritchett J W. Supracondylar fractures of the femur.  Clin Orthop. 1984;  184 173-177
• 16 Sanders R, Swiontkowski M, Rosen H, Helfet D. Double-plating of comminuted, unstable fractures of the distal part of the femur.  J Bone Joint Surg [Am]. 1991;  73 341-346
• 17 Schatzker J, Horne G, Waddell J. The Toronto experience with supracondylar fracture of the femur 1974,. 1966-1972. Injury 6: 113-128
• 18 Schatzker J, Lambert D C. Supracondylar fractures of the femur.  Clin Orthop. 1979;  138 77-83
• 19 Siliski J M, Mahring M, Hofer H P. Supracondylar-intercondylar fractures of the femur: Treatment by internal fixation.  J Bone Joint Surg [Am]. 1989;  71 95-104
• 20 Weber D, Pomeroy D L, Schaper L A, Badenhausen Jr W E, Curry J I, Smith M W, Suthers K E. Supracondylar nailing of distal periprosthetic femoral fractures.  Int Orthop. 2000;  24 (1) 33-35
• 21 Wick M, Muller E J, Muhr G. Supracondylar femoral fractures in knee endoprostheses. Stabilizing with retrograde interlocking nail.  Unfallchirurg. 2001;  104 (5) 410-413