Type C 1 and 2 Fractures of the Distal Femur Treated with a Retrograde Nail: Knee Recovery at Six Years Follow-Up

Abstract

Purpose: The object of this study was to assess the function of the knee joint and the development of post-traumatic arthritis at a minimum of six years in patients in whom an intra-articular distal femoral fracture had been treated with a reamed retrograde intramedullary nail. Methods: This is a retrospective study of thirty intercondylar-supracondylar femoral fractures treated with a reamed retrograde nailing. According to the OTA classification, there were 19 (63 %) type C 1 fractures and 11 (37 %) type C 2 fractures. The operative technique included reduction of the fracture, minimal internal fixation and the insertion of a retrograde interlocked intramedullary nail. Follow-up ranged from 61 to 84 months (average: 72 months). Functional results were assessed using the Neer score and the radiographic appearance of post-traumatic arthritis using the Ahlback score. Results: Fourteen fractures (46.6 %) achieved an excellent Neer score and only three fractures (10 %) a poor Neer score. No correlation was found between the type of fracture and the final score (p = 0.763). No significant correlation was found between the final Ahlback and Neer scores (p = 0.162). Conclusions: A high percentage of radiographic post-traumatic arthritis should be expected after intra-articular femoral fractures that have been treated with intramedullary nailing. However, because all the objectives of the fracture treatment can be obtained, the functional results remain satisfactory over time.