Treatment of distal femur fractures with retrograde intramedullary nailing utilizing a tibial nail

Abstract

Abstract
 Aim
 Retrograde intramedullary nailing for the treatment of femur fractures is a sound option due to its advantages including ease of implant placement and better control of the distal segment, especially in distal femur fractures. Unfortunately, retrograde femoral nails are not available in most developing countries or rural areas. The primary aim of the study is to investigate the outcomes of an alternative treatment of distal femur fracture with retrograde intramedullary nailing using a tibial nail. 
 Material and Method
 Patients who had distal femur fractures and underwent retrograde intramedullary nailing with a tibial nail between January 2020 – March 2022 are retrospectively evaluated. Patients who were treated other than a tibial nail, aged below 18, had follow-up less than 6 months, multiple fractures, and open fractures were excluded. Patients’ demographics, time to union, and complications were recorded. Functional outcomes included visual analogue pain score (VAS), Lysholm score, Tegner activity scale, Knee Society Score (KSS), and Short Form-36 (SF36) on the latest follow-up.
 Results
 A total of 15 patients (11 male, 4 female) met the inclusion criteria and included in the study. The mean age of the patients was 42.9 ± 17.3 (range, 18 to 72) months. The mean follow-up period was 10.1 ± 5.2 (range, 6 to 18). There was no reduction loss and implant failure during follow-ups. One patient had nonunion. No intraoperative fracture occurred. Persistent knee pain was seen in a patient due to an intraarticular screw and removed arthroscopically. In the latest follow-up, the mean VAS was 0.73 ± 0.70 (range, 0 to2), the mean Tegner score was 5.0 ± 1.5 (range, 3 to 7), the mean Lysholm score was 90.9 ± 9.9(range, 64 to 100), the mean KSS was 86.6 ± 8.6 (range, 70 to 97), and the mean SF-36 score was 96.5 ± 4.7 (range, 87 to 100). 
 Conclusion
 The results of this study suggest that a tibial nail with retrograde intramedullary nailing has good functional outcomes in the treatment of distal femur fractures. The tibial nail should be considered as an alternative treatment option where distal femoral nails are not available.