The incidence of distal femur fractures is around 37/100,000 patients per year [1]. Characteristically, two separate mechanisms of injury cause distal femur fractures. In the elder population with osteoporotic bone and susceptible soft tissue envelope, distal femoral fractures occur predominately after low energy trauma, e.g., falls and sprain injuries complicated by a high rate of comorbidity (60% female, older than 60 years). In young patients (60% male, younger than 40 years), high energy trauma causes complex injury with comminuted and open fracture pattern. Approx. 30% of patients with distal femur fractures are poly traumatized. 40% had soft tissue injuries, 10% had ligamentous lesions, 8% had meniscal lesions, 10% had dissected cartilage fragments and 15% had patella fractures and 38% of supracondylar/intercondylar distal femoral fractures have a coronal plane fracture [2][3][4][5][6]. Intramedullary femoral nailing has classically been performed using antegrade entry from piriformis fossa and has produced excellent results. Winquist et al had 99.1% union rate with postoperative knee ROM averaging 130degree and 0.9% infection rate [7]. Since antegrade nail has been so successful there has been resistance in surgeons to accept retrograde nailing as an alternative as shown in Figure 1 & 2; [8].Retrograde nailing has a benefit over other techniques, viz

Background: Fractures of distal femur are complex and nearly all of times a tailored approach is required for these fractures. Over a phase of time variety of approaches and implants have been used for these fractures. The use of retrograde femur nail for fixing femur fracture, by means of entry from intercondylar notch of femur, is a recognized technique of treatment, but the majority surgeons are concerned of making an entry from the knee joint because of possible complications like knee pain, arthro-fibrosis, infections etc. The aim of this study was to look into its effectiveness in fixation of distal 1/3 rd fracture of femur with particular emphasis on the outcome and inherent surgical challenges. Methods: A prospective study of 45 patients with fracture femur distal one third were treated by retrograde nailing, from Aug 2018 to Aug 2020, after obtaining necessary approval from the Institutional ethical & research committee. All the patients were followed till fracture union and evaluated on the basis of demography, length of healing, complications and surgical challenges. Results: We observed that mean age of patients was 46.5 years (18 years to 75 years) where 75% were male and 25% were female. Average duration of healing was 24 weeks (ranging from 10 weeks to 40 weeks) with 100% healing achieved. Mean knee range of motion was 124 degree, rate of knee pain 10%, Re-operation rate 2.2%, infection rate 2.2%. Conclusions: Retrograde femoral nailing is a dependable option to antegrade nailing or plate fixation for diaphyseal fracture distal one third femur, and might be even advantageous when antegrade nail entry is challenging like ipsilateral hip fractures, previous implant in hip & proximal femur, ipsilateral pelviacetabular injury, bilateral femoral shaft fracture, floating Knee injuries, poly-trauma and obese patients.

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Background Navigated total knee replacements (TKR) have shown better knee function and quality of life. It also reduces revision rates. The aim of our study is to evaluate short to mid-term clinico-radiological and functional results, survival rate and complications of Gradius knee prosthesis implanted using computer navigation. Methods We retrospectively reviewed 120 Gradius knee prosthesis, implanted in 68 patients (52 bilateral TKR and 16 unilateral TKR) and followed from Jan 2015 till Jan 2020. Pre-operative & post-operative radiographs, knee society scores (KSS), range of motion (ROM), deformity assessment and gait video recordings were done for all patients. Results The mean follow-up was 3.8 years (minimum 2-5 years).The mean ROM was 2° (0-10) extension to 135° (128°-138°) flexion. The KSS pain score improved from mean of 38.3 (range 26-44) to 90.4 (mean 88-92). The KSS functional score improved from 36.2 (range 28-39) to 92.6 (range 86-94). All patients had excellent to good function during successive follow-ups. The coronal alignment improved from 8° varus to 0.3° varus. Sagittal alignment was corrected from 8° (4°-18°) preoperatively to 2° (0°-8°) postoperatively Conclusion At mid-term our series outlines the better functional and radiological results of Gradius knee prosthesis using navigation as a tool. We recommend a prospective randomized controlled trials comparing navigated versus non-navigated for Gradius knee prosthesis with long-term follow-up.