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Outcomes of retrograde nailing of distal femoral fractures in Indian population: a prospective study

Mukesh N Shah, Josal S Patel.

Background: Distal femur fractures are tough to handle, and the choice of implant for internal fixation remains controversial. One of the therapeutic principles that can be employed for the treatment of distal femoral fractures is retrograde intramedullary nailing, which follows the principle of biological osteosynthesis.

Objective: To investigate in a retrospective manner the results of retrograde nailing in distal femoral fractures and selected cases of femoral shaft fractures. Emphasis was posed on long-term functional outcome, especially in daily activities.

Materials and Methods: Retrograde femoral nailing was used from January 2010 to October 2015 in level 1 trauma center for the treatment of various types of femoral fractures (AO/ASIF-type 32/33) in 20 patients with 21 fractures. Patients were followed up till fracture healing and invited to a functional follow-up using Neer’s knee scoring system.

Result: Osseous healing occurred in shaft fractures in 18.33 weeks on an average when compared with 15.25 weeks in supracondylar fractures. Stiffness was seen as only late postoperative complication in five of 19 (26.31%) patients beyond 1 year of postoperation. Two patients with pathological fracture died on follow-up owing to metastasis. After a mean 20.4 month follow-up, the mean scores were 85 in shaft and 74 in distal femoral fractures (I/A and E/A). Motion was better in shaft fractures (arc of motion—mean: 116.67°) than in distal femoral fractures (arc of motion—mean: 102.18°).

Conclusion: Retrograde nailing represents a reliable fixation method for extra-articular (33A) and intra-articular (33C) fractures of the supracondylar area. In femoral shaft fractures, retrograde inserted nails offer a valuable alternative, especially when the proximal femoral approach is obstructed. There is a need of methodologically sound clinical trials to generate high quality evidence for efficacy of retrograde nailing.

Key words: Retrograde nailing, femoral fractures, supracondylar femoral fractures, Neer’s knee scoring

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