Retrograde Nailing of Distal Femoral Fracture – Clear and Potential Indications

Abstract

Despite the fact that fracture treatment of the supracondylar region of the femur is known to be a therapeutic challenge, a high incidence of complications was reported with extramedullary osteosynthesis. New techniques of biological osteosynthesis and specific implants have been developed to improve treatment of supra-and diacondylar fractures of the femur. In the present series, we report on various clear indications for the use of the distal femur nail (DFN). Moreover, some potential indications for the DFN are presented and their advantages discussed. Clinical evaluation demonstrated that 92% of the fractures treated with the DFN healed without bone grafting, and the clinical results were excellent or satisfactory according to the criteria of Neer et al. Failure of the technique or infection was not observed. Based on our results, we feel that retrograde nailing of the femur, either with percutaneous or open techniques, is a suitable additition to the established techniques of osteosynthesis of the distal femur.

Retrograde Marknagelung bei periprothetischen Frakturen des distalen Femurs

“…Dies ist die Grundlage der weit verbreiteten Klassifikation nach Rorabeck [15,17,21] Grundsätzlich weist der retrograde Femurnagel gegenüber der Plattenosteosynthese einige Vorzüge auf: Winkelstabile Platten besitzen eine beträchtliche Materialstärke, dementsprechend können sie Weichteilirritationen und Schmerzen verursachen. Bei der retrograden Nagelung dagegen handelt es sich um ein minimal-invasives Verfahren, die femoralen Weichteile werden weitgehend geschont [18,19,22,24,27]. Gleichzeitig trägt der intramedulläre Kraftträger nicht auf und bietet eine überlegene axiale Stabilität, die post operativ unmittelbar eine schmerzabhängige Vollbelastung erlaubt.…”

Retrograde Intramedullary Nailing for Femoral Shaft Fractures in Elderly Patients with Previous Ipsilateral Dynamic Hip Screw Fixation

“…This method yields high union and low complication rates when vigilance is maintained during pre-operative planning, the surgical procedure and the post-operative period [10,19,20] . Antegrade or retrograde intramedullary nailing may be performed; however, each option has relative advantages, disadvantages and indications [12] . Our choice of retrograde nailing was dictated by the presence of proximal implants in the femur.…”

“…A non-operative management with traction is not well tolerated by elderly patients and carries a high risk of complications [8,9] . Extramedullary load-bearing devices like plate fixations used for the treatment of these fractures have the drawbacks of surgical morbidity and implant failure because of inherent mechanical disadvantages being subjected to tension forces [10][11][12] . We present our experience in managing femoral shaft fractures in elderly patients with a previous ipsilateral DHS fixation for extracapsular neck of femur fractures using retrograde intramedullary nailing implants.…”

Retrograde Intramedullary Interlocking Nail: An Optimal Tool for the Treatment of Supracondylar Femoral Fractures

“…(22,23) Recent studies show union and complication rates comparable to ante grade nails, with the exception of a higher incidence of knee pain in the retrograde technique. (24,25,26,27) However, there are no reports of long term knee joint effects after retrograde nailing done transarticularly. (28) Currently accepted indications for retrograde femoral nails are similar to those for ante grade nailing.…”

“…(24,25,26,29,30,31) Advantages include minimal soft tissue exposure, closed reduction technique, shorter operating time, minimal blood loss and early recovery. There is need to put supracondylar nailing surgery into practice for distal femoral fractures because it is minimally invasive technique, better fixation and control of distal fragment, preservation of periosteal and fracture haematoma, negligible blood loss, less chance of post-operative infection, faster union and weight bearing associated with this procedure.…”