Retrograde Versus Antegrade Intramedullary Nailing of Gunshot Diaphyseal Femur Fractures

Abstract

Background The use of retrograde nailing for gunshot wound femur fractures is controversial due to concerns of knee sepsis after this procedure since the knee is entered to introduce the nail into the canal. Questions/purposes We compared retrograde and antegrade nailing for gunshot femur fractures to determine whether (1) knee sepsis or other adverse events were more likely to complicate procedures using retrograde nails, (2) there were differences in surgical time or blood loss, and (3) there were differences in radiographic union.Methods We retrospectively reviewed our prospective trauma database from 1999 to 2012 for patients with a diagnosis of gunshot and femur fracture. We performed a detailed review of medical records and radiographs for those patients with OTA Classification Type 32 femur fractures secondary to gunshot injury treated with either retrograde or antegrade femoral nailing. Eighty-one patients were treated with intramedullary nailing (53 retrograde and 28 antegrade). We reviewed elements of the operative treatment (procedure, anesthesia time, operative time, and estimated blood loss) for all 81 patients. For clinical and radiographic review, followup was adequate for 43 and 25 patients with retrograde and antegrade nailing, respectively. Minimum followup was 3 months for both groups (retrograde: mean, 41 months; range, 3-148 months; antegrade: 26 months: range, 3-112 months). Results No patients in either group developed knee sepsis. No significant differences were found between groups with regard to operative time, blood loss, or radiographic union. Conclusions With the numbers available, immediate retrograde nailing appears as safe and effective as antegrade nailing for gunshot femur fractures. Immediate retrograde nailing is as safe as antegrade nailing for gunshot femur fractures. Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Civilian Ballistic Femoral Shaft Fractures Compared With Blunt Femur Shaft Fractures

“…Ricci et al showed that both antegrade and retrograde nailing of femoral shaft fractures go on to successful union approximately 89% and 88% of the time, respectively, 23 and reoperation because of fracture nonunion is relatively uncommon when femoral shaft fractures are treated with intramedullary devices. Dougherty et al 24 also found no differences about operative time, blood loss, or radiographic union when comparing retrograde with antegrade nailing for ballistic femur fractures. Our results showed ballistic femoral shaft fractures with a 4% nonunion rate that closely resembled blunt closed fractures (4.0% vs. 5.0%) and was less common than the blunt open fractures, which had a nonunion rate of 9.0%.…”

Clinical outcomes of the intramedullary femoral nailing system in the treatment of femoral fractures

“…It has been indicated that intramedullary nail fixation is the preferred choice for treating femur fractures if complete weight bearing is a consideration. [3][4][5][6][7][8][9][10] The present study shows the treatment of Femoral fracture using an intramedullary nailing device which was designed and manufactured by Kaulmed private limited, India.…”

Firearm-Related Injuries—Wound Management, Stabilization, and Associated Injuries

“…Intramedullary nail fixation has shown comparable time to union for low-energy ballistic diaphyseal femur when compared with closed fractures 51-53 . Retrograde nail fixation has likewise demonstrated similar success without evidence of the theoretical increased risk of knee septic arthritis after low-energy ballistic femur fractures 54,55 . As with all intramedullary fixation techniques, assessment of length and rotation is critical and may present specific challenges in the ballistic population with higher rates of postoperative rotational and length errors 56 .…”