Retrograde intramedullary interlocking nailing in fractures of the distal femur

• Published in: Acta orthopaedica et traumatologica turcica Vol. 43; no. 3; pp. 199 - 205
• Main Authors: Gurkan, Volkan, Orhun, Haldun, Doganay, Murat, Salioğlu, Faruk, Ercan, Tarcan, Dursun, Muhsin, Bülbül, Murat
• Format: Journal Article
• Language: English
• Published: Turkey 01-05-2009
• Subjects: Adult; Aged; Bone Nails; Equipment Design; Female; Femoral Fractures - classification; Femoral Fractures - diagnostic imaging; Femoral Fractures - surgery; Femur Neck; Functional Laterality; Humans; Knee Joint - physiopathology; Male; Middle Aged; Radiography; Range of Motion, Articular
• ISSN: 1017-995X
• DOI: 10.3944/AOTT.2009.199

We evaluated retrograde locked intramedullary nail applications in patients with distal femur fractures.
Distal femur fractures of 16 patients (11 males, 5 females; mean age 45 years; range 25 to 69 years) were treated with retrograde locked intramedullary nailing. One patient had bilateral fractures. According to the AO classification, the fractures were A1 (n=8), A2 (n=4), A3 (n=4), and C1 (n=1). There were 13 closed (76.5%), and four open (23.5%) fractures. The mean time to surgery was 10 days (range 2 to 20 days). Open technique was used for nine fractures, and percutaneous technique for eight fractures. Preoperatively, three patients with a floating knee were evaluated with magnetic resonance imaging and were found to have a ruptured cruciate ligament. All patients underwent intraoperative knee examination, which showed a ruptured cruciate ligament in five patients. Functional results were assessed using the modified HSS (Hospital for Special Surgery) knee rating scale at the end of a mean follow-up period of 32.6 months (range (12 to 68 months).
The mean time to union was 25 weeks (range 14 to 42 weeks). One patient had delayed union (42 weeks). Joint range of motion was normal in three knees (17.7%), was 100 to 110 degrees in nine knees (52.9%), 80 degrees in four knees (23.5%), and below 80 degrees in one knee (5.9%). According to the modified HSS knee scale, the results were excellent in five femurs (29.4%), good in six femurs (35.3%), moderate in five femurs, and poor in one femur (5.9%). Postoperative radiographic examination showed varus angulation (10 degrees ) in four patients (23.5%), and posterior angulation (10-20 degrees ) in four patients. In one patient, healing occurred with extreme deformation (30 degrees posterior angulation). None of the patients experienced wound site problems or infections. One patient developed deep vein thrombosis in the early postoperative period.
Treatment of distal femur fractures with retrograde locked intramedullary nailing yields satisfactory results in adults.