Clinical Outcome of Retrograde Nailing of Femoral Fractures in the Elderly

Abstract

Since October 1994, 55 cases of distal femoral fractures in 55 patients (47 female and 8 male) were stabilized by closed genucephalic nailing at the Department of Traumatology, Vienna General Hospital (level 1 trauma center). Average age at time of operation was 72 years (16-97 years), 31 patients were older than 70 years. Indications according to the AO classification were fractures type 33A1 (n = 25), 33A3 (n = 9), 33C2 (n = 10) and others (n = 11). In 22 cases the fracture occurred ipsilateral to a hip prosthesis or osteosynthesis of the proximal femur. Five fractures were proximal to total knee prostheses, two were combined with a Hoffa fracture. Peri- and intra-operative complications were miss-drilling in six cases, two of which led to femoral fracture at the tip of the nail. Breakage of interlocking screws occurred in three cases. There were no infections of implant or cases of thrombo-embolism. Ten patients died before fracture healing due to cardiac or pulmonary reasons. Primary union of the fracture was observed between 10 and 20 weeks postoperatively in 44 patients. One patient underwent revision surgery for pseudarthrosis. 38 patients were followed for an average period of 21 months. Evaluation was according to Leung score for distal femoral fractures (1991): 14 patients were rated as excellent, 11 as good, 5 as fair and 8 as poor with a mean score of 75 points (maximum: 97 points). The results confirm the method of retrograde femoral nailing to be a reasonable alternative to plate osteosynthesis in AO 33A and C fractures, allowing early mobilization and good knee function. However, in the elderly patient satisfactory operative results are not easy to achieve due to osteopenic bone. Functional results remain limited because of high co-morbidity in this population.

Key words

Retrograde nailing - distal femoral fracture - fractures in the elderly

References

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