Retrograde Intramedullary Nailing of Femoral Diaphyseal Fractures Caused by Low-velocity Gunshots

Abstract

The purpose of this study was to evaluate the results of retrograde intramedullary nailing of femoral diaphyseal fractures caused by low-velocity gunshots. Seventy-three patients (68 men and 5 women) with 74 femoral diaphyseal fractures caused by gunshots were treated with reamed, retrograde, statically locked intramedullary nailing. The main outcome measures were fracture union, the need for additional operations, shortening, angular deformity, postoperative knee range of motion, and complication rate. Twenty-nine patients sustained additional injuries. During initial treatment, 18 patients underwent further orthopedic and nonorthopedic elective procedures. Three patients had fasciotomies for compartment syndrome. At follow-up, 3 patients had shortening >10 mm (range, 12-18 mm) and 1 had angulation >10 degrees (13 degrees recurvatum). Four patients underwent surgeries after discharge. Complications included 1 case of heterotopic bone formation, 1 hypertrophic nonunion that went on to union after dynamization, 2 postoperative positive blood cultures, and 1 wound dehiscence. There were no cases of septic arthritis. Our data indicate that there is a low incidence of shortening, angular deformity, complication, and infection rates following treatment of femoral gunshot diaphyseal fractures with a retrograde nail. This study demonstrates that this is an acceptable alternative for the treatment of these injuries.

Intramedullary nailing of subtrochanteric femur fractures caused by low velocity gunshots

“…2 We found that 18% of the patients in our group had associated injuries. These include a whole array of additional soft tissue and extremity injuries secondary to the gunshot wounds to significant life-threatening injuries, including abdominal and pelvic injuries.…”

“…Femur fractures are the most common orthopaedic injury due to gunshots 2 and locked intramedullary nailing is the mainstay of treatment for diaphyseal femur fractures. 3 Femur fractures from ballistic injuries, in particular, are often comminuted which may complicate pre-operative planning and affect outcomes (Figures 1a and 1b).…”

Retrograde Versus Antegrade Intramedullary Nailing of Gunshot Diaphyseal Femur Fractures

“…To be able to use this device with gunshot femur fractures may be an advantage in certain cases. We are aware of only two clinical case series of retrograde IM nailing for gunshot femur fractures [2,9] but none comparing retrograde and antegrade nailing for patients with gunshot femur fractures. To our knowledge, our study is the first to compare the two groups with regard to the end points of knee sepsis and other complications, anesthetic and operative times, blood loss, and fracture union.…”

“…Cannada et al [2] retrospectively reviewed 73 patients with 74 gunshot femur fractures treated with reamed retrograde nailing at two institutions. Thirty-five patients (48%) were followed an average of 7 months after surgery, with no reported knee sepsis.…”

“…One study of 15 patients with supracondylar femur fractures (defined as high velocity or low velocity) treated with a short IM nail reviewed the outcomes an average of 14 months after injury [9]. A second retrospective review was performed on 73 patients with 74 low-velocity gunshot femur fractures [2]. Average followup for 35 of these patients was 7 months.…”