Long-term functional outcome of knee after antegrade versus retrograde intramedullary nailing for femoral fracture

Abstract

ObjectivesTo evaluate functional outcomes of the knee after antegrade and retrograde intramedullary nailing for femoral shaft fractures in adults.BackgroundAntegrade reamed interlocked intramedullary nailing is the treatment of choice for femoral diaphyseal fractures. More recently, retrograde intramedullary nailing of the femur has been seen as a viable alternative to the antegrade nailing.Patients and methodsThis was a prospective comparative study. A total of 40 patients were divided randomly by a closed envelope technique into two equal group: group A (antegrade nailing) and group B (retrograde nailing). A total of 20 patients with shaft femur fractures had interlocking intramedullary fixation via the antegrade nailing approach (group A), whereas another 20 patients with shaft femur fractures had fixation via the retrograde approach (group B).ResultsThe mean age of group A was 25.10 ± 10.41 years and 31.35 ± 10.11 years in group B. There were no significant adverse effects reported in both groups. The mean follow-up duration was 25.20 ± 8.39 months in group A and 25.00 ± 6.91 months in group B (P = 0.759). The mean Tegner Lysholm knee scoring scale was 94.05 ± 4.43 in group A and 82.45 ± 8.83 in the group B (P < 0.0001). Regarding Tegner Lysholm knee scoring scale categorization, group A recorded 90% as excellent, whereas group B revealed 65% as good.ConclusionOur study suggests that antegrade intramedullary femoral nailing fixation is favorable over retrograde nailing in knee function, range of motion, and knee pain for diaphyseal femoral fracture in adults using Lysholm knee function scoring.