Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur

Demirtaş, Abdullah; Azboy, İbrahim; Özkul, Emin; Gem, Mehmet; Alemdar, Celil

doi:10.3944/aott.2014.14.0004

Cited by 35 publications

(29 citation statements)

References 8 publications

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“…used the same fracture model and compared the biomechanical properties of three different intramedullary nails (SCN, DFN, and T2 intramedullary nails) and the AxSOS locking plate, and found that the torsional stiffness of the locking plate was greater than for the intramedullary fixation system; SCN had the largest axial stiffness, followed by DFN, T2 intramedullary nails, and the locking plate, which was consistent with our experimental results. Similar results have been reported in several other biomechanical and clinical studies.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Less Invasive Stabilization System Plate and Retrograde Intramedullary Nail in the Fixation of Femoral Supracondylar Fractures in the Elderly: A Biomechanical Study

Wang³

et al. 2019

Orthopaedic Surgery

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Objective To compare the biomechanical stabilities of less invasive stabilization system (LISS) plate and retrograde intramedullary nail (IMN) for the comminuted femoral supracondylar fracture fractures in the elderly. Methods Sixteen pairs of embalmed cadaver femurs were obtained to simulate a comminuted supracondylar femur fracture (AO/OTA33‐A3) gap model. All left‐side specimens were fixed with LISS plate, and retrograde IMN were applied to the right‐side specimens. All specimens were tested in torsional, axial and cyclic load mode on an Instron testing machine. Results The mean torsional stiffness for LISS plate group was 34.1% greater than retrograde IMN group (2.90 vs. 1.91 Nm/degree, P = 0.002), but the mean axial stiffness was greater for the retrograde IMN (199.16 vs. 303.93 N/mm, P < 0.001). The total deformation of LISS plate caused by cyclic axial loading was greater than retrograde IMN (4.17 vs. 3.57 mm, P = 0.014). Significantly less mean irreversible deformation was detected in LISS plate than in retrograde IMN (1.64 vs. 1.69 mm, P = 0.699). Failure loads of the constructs were significantly different between the two groups (LISS plate: 2941±128 N; retrograde IMN: 4022±176 N, P < 0.001). Conclusion For comminuted femoral supracondylar fractures in the elderly, the tested instruments can both maintain sufficient biomechanical stabilities, but retrograde IMN is superior to LISS plate in deformation of fracture site.

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Section: Discussionsupporting

confidence: 92%

Comparison of Less Invasive Stabilization System Plate and Retrograde Intramedullary Nail in the Fixation of Femoral Supracondylar Fractures in the Elderly: A Biomechanical Study

Wang³

et al. 2019

Orthopaedic Surgery

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“…6,10 However, the mean time for fracture union was less than that for bridge plating which could be due to preservation of fracture hematoma and early postoperative weight bearing in retrograde nailing as shown in Figure 3. 11,12 Average time taken for union in open fractures was 21.3 weeks which was comparable with the previous studies. 13 In our study, 3 patients (14.3%) who had fractures at the middle-distal third junction had features of delayed union and underwent dynamization as a secondary procedure.…”

Section: Discussionsupporting

confidence: 87%

“…This is comparable to the reports in the previous studies. 11 One complication which was noted in our study was the stress fracture at the tip of the nail. This could be due to the exaggerated anterolateral bowing of femur in osteoporotic bone which causes stress rising at the proximal fixation point.…”

Section: Discussionmentioning

confidence: 53%

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Retrograde intramedullary nailing for fractures of distal femur: a prospective study

Dileep

Mahesha

2016

Int J Res Orthop

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Background: The objective of the present study was to evaluate the clinical and functional outcome of retrograde intramedullary interlocking nailing for fractures of distal femur.Methods: This two-year prospective observational study includes all patients with fractures of distal femur who underwent retrograde intramedullary interlocking nailing. The patient was placed supine on fracture table with the affected limb flexed to 60o. Through a transpatellar approach, the nail was introduced in a retrograde method after serial reaming. Postoperatively knee range of motion was started immediately and weight-bearing was progressed after signs of fracture union were noted on x-rays. The outcome was evaluated for time taken for fracture union, complications and secondary procedures, knee range of motion and function at 1 year follow up using modified knee-rating scale of the hospital for special surgery.Results: There were 21 patients who underwent retrograde intramedullary nailing for fractures of distal femur during the study period. According to AO/ASIF system, fractures were classified as A1 (n=15), A2 (n=3), and A3 (n=3). In 17 patients, fracture united without complications or secondary procedures. Fractures united at a mean time of 19.4 weeks. There were no varus or valgus malalignments but one patient had significant limb shortening. At the end of 1 year, excellent to good functional outcome was noted in 81% of patients. Conclusions: Retrograde intramedullary nail fixation is a reliable method for treatment of fractures of distal femur. It promotes high rates of fracture union with minimal complications. This method does not interfere significantly with the knee function postoperatively.

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“…19 However, although no plate was present laterally, it was still found that the main complication with retrograde nailing was the prominence of distal locking screws. 22,37 Finally, it was shown by Demirtas et al 37 that the complications, union rate, and functional results of modern intramedullary nailing are no different than that of modern plating technology for extraarticular distal femoral fractures. A recent study on the fixation of distal femoral fractures with retrograde intramedullary nailing has demonstrated that modern locked plating and nailing present no significant difference in loadto-failure and that nails undergo less plastic deformation than plates.…”

Section: Intramedullary Nailingmentioning

confidence: 99%

Osteoporotic distal femoral fractures

Hagedorn

Achor

2016

Current Orthopaedic Practice

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Osteoporotic distal femoral fractures are complex problems to treat. As the population continues to age, orthopaedic surgeons must be aware of the challenges involved in treating these injuries. Obtaining and maintaining reduction until healing is a difficult challenge when the patient has poor bone quality. Current options for treatment include fixed angle constructs, such as angled blade plates and dynamic condylar screws, locked plating, retrograde intramedullary nailing, and replacement of the distal femur. Each treatment option has benefits and drawbacks. The goal of treatment remains minimizing complications while facilitating mobilization. FIGURE 2. A 63-year-old female stepped awkwardly off a curb, sustaining a fracture of the distal femur. (A) Injury anteroposterior radiograph. (B) Axial CT scan at the joint, revealing a nondisplaced intercondylar split. (C) Intraoperative fluoroscopic view showing start site for a retrograde nail, following placement of two interfragmentary lag screws across the condylar split. (D and E) Healed radiographs at 1-

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Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur

Abstract: Bridge plating and RIMN have similar results in the treatment of extra-articular distal femur fractures. Both methods can be applied to all fractures, with the exception of Gustilo-Anderson Type 3B and C open fractures.

Cited by 35 publications

References 8 publications

Comparison of Less Invasive Stabilization System Plate and Retrograde Intramedullary Nail in the Fixation of Femoral Supracondylar Fractures in the Elderly: A Biomechanical Study

Comparison of Less Invasive Stabilization System Plate and Retrograde Intramedullary Nail in the Fixation of Femoral Supracondylar Fractures in the Elderly: A Biomechanical Study

Retrograde intramedullary nailing for fractures of distal femur: a prospective study

Osteoporotic distal femoral fractures

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