Anterograde Intramedullary Nailing Research Articles

Systematic review of humeral shaft fracture (OTA/AO 12) complicated with iatrogenic radial nerve injury

ObjectivesTo compare the iatrogenic radial nerve injury (iRNI) rate of different implant (plate vs. intramedullary nail) and surgical approaches during humeral shaft fracture surgery.MethodsThe online PubMed database was used to search for articles describing iRNI after humeral fracture with a publication date from Jan 2000 to October 2023. The following types of articles were selected: (1) case series associating with adult humeral shaft fracture, preoperative radial nerve continuity, non-pathological fracture and non-periprosthetic fracture; (2) involving humeral shaft (OTA/AO 12) fractures. Articles where we were unable to judge surgical approach or fracture pattern (OTA/AO 12) were excluded. The data were analyzed by SPSS 27.0 and Chi-square test was performed to identify incidence of iRNI associated with different implant and surgical approaches.ResultsFifty-four articles with 5063 cases were included, with 3510 cases of the plate, 830 cases of intramedullary nail and 723 cases of uncertain internal fixation. The incidences of iRNI with plate and intramedullary nail were 5.95% (209/3510) and 2.77% (23/830) (p < 0.05). And iRNI incidences of different surgical approaches were 3.7% (3/82) for deltopectoral approach, 5.74% (76/1323) for anterolateral approach, 13.54% (26/192) for lateral approach and 6.68% (50/749) for posterior approach. The iRNI rates were 0.00% (0/33) for anteromedial MIPO, 2.67% (10/374) for anterolateral MIPO and 5.40% (2/37) for posterior MIPO (p > 0.05). The iRNI rates were 2.87% (21/732) for anterograde intramedullary nail and 2.04% (2/98) for retrograde intramedullary nail (p > 0.05). In humeral bone nonunion surgery, the rate of iRNI was 15.00% (9/60) for anterolateral approach, 16.7% (2/12) for lateral approach and 18.2% (6/33) for posterior approach (p > 0.05).ConclusionIntramedullary nailing is the preferred method of internal fixation for humeral shaft fractures that has the lowest rate of iRNI. Compared with anterolateral and posterior approaches, the lateral surgical approach had a higher incidence of iRNI. The rate of iRNI in MIPO was lower than that in open reduction and internal fixation.Level of evidenceLevel IV.

Le double verrouillage distal dans l’enclouage centromédullaire des fractures diaphysaires de l’humérus réduit-il le taux de pseudarthrose ?

Introduction: Intramedullary nailing is one of the surgical treatments for humeral shaft fracture. Non-union is a common complication, with rates of 10-20%. The objective of this study was to compare non-union in humeral shaft fractures treated by intramedullary nailing with double distal locking, single distal locking or no locking.Hypothesis: Nailing with double distal locking decreases non-union rates compared to single or no locking.Material and Methods: This single-center retrospective comparative study included 87 patients with closed humeral shaft fracture without neurologic deficit treated by anterograde intramedullary nailing: group 1 (double locking): 15 fractures; group 2 (single locking): 63 fractures; group 3 (no locking): 9 fractures. Non-union was defined as absence of radiographic callus at 6 months without clinical pain. The primary endpoint was non-union rate per group. The secondary endpoints were Constant score at 6 months, and postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs).Results: There were no significant differences in non-union rate: 20.0% in group 1, 20.3% in group 2, and 0% in group 3 (p = 0.32). Constant score at 6 months was significantly different between the 3 groups (p = 0.01). Group 2 used more NSAIDs than the other groups (39.1% vs 20.0% in group 1 and 33.3% in group 3; p = 0.37).Discussion: Non-union rates were similar regardless of distal locking for closed humeral shaft fractures without neurologic deficit treated by intramedullary nailing. Nevertheless, patients in the double locking group had higher Constant scores at 6 months, probably related to greater stability of fixation, allowing more efficient rehabilitation.Level of evidence: III; Retrospective comparative study

Does double distal locking reduce non-union rates in intramedullary nailing for humeral shaft fracture?

IntroductionIntramedullary nailing is one of the surgical treatments for humeral shaft fracture. Non-union is a common complication, with rates of 10–20%. The objective of this study was to compare non-union in humeral shaft fractures treated by intramedullary nailing with double distal locking, single distal locking or no locking. HypothesisNailing with double distal locking decreases non-union rates compared to single or no locking. Material and methodsThis single-center retrospective comparative study included 87 patients with closed humeral shaft fracture without neurologic deficit treated by anterograde intramedullary nailing: group 1 (double locking): 15 fractures; group 2 (single locking): 63 fractures; group 3 (no locking): 9 fractures. Non-union was defined as absence of radiographic callus at 6 months without clinical pain. The primary endpoint was non-union rate per group. The secondary endpoints were Constant score at 6 months, and postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs). ResultsThere were no significant differences in non-union rate: 20.0% in group 1, 20.3% in group 2, and 0% in group 3 (p=0.32). Constant score at 6 months was significantly different between the 3 groups (p=0.01). Group 2 used more NSAIDs than the other groups (39.1% vs. 20.0% in group 1 and 33.3% in group 3; p=0.37). DiscussionNon-union rates were similar regardless of distal locking for closed humeral shaft fractures without neurologic deficit treated by intramedullary nailing. Nevertheless, patients in the double locking group had higher Constant scores at 6 months, probably related to greater stability of fixation, allowing more efficient rehabilitation. Level of evidenceIII; retrospective comparative study.

The comparison of the Effect of double reverse traction repositor (DRTR) and traction table assisted Anterograde Intramedullary nail in treatment of femoral shaft fractures

ObjectiveThe objective of this study was to compare the clinical efficacy of DRTR (Double Reverse Traction Repositor, DRTR)and traction table in the treatment of femoral shaft fractures with the aid of AN-IMN (Antegrade intramedullary nailing).Patients and MethodsIn this study, patients with femoral shaft fractures admitted to the Department of Orthopedics at Zhaoqing First People’s Hospital from May 2018 to October 2022 were recruited. All patients were treated with anterograde intramedullary nailing, with 23 patients in the DRTR-assisted group and 21 patients in the traction table-assisted group. The demographic characteristics, fracture classification, intraoperative data, postoperative data, and prognostic indicators of the two groups were recorded and analyzed retrospectively. All procedures were performed by the same team of experienced physicians.ResultsAll the patients in the two groups were followed up for more than 12 months. Both traction methods could provide stable traction for the operator during AN-IMN, and there was no significant difference in demographic characteristics and fracture classification. The intraoperative fluoroscopy times and opening reduction rate of the DRTR group were lower than those of the traction table group (P < 0.05), and the postoperative Harris Hip Score, as well as the Lyshol Lysholm knee function Score of the DRTR group, were significantly higher than the traction table group members (P < 0.05). Postoperative complications such as perineal soft tissue injury and lateral femoral cutaneous nerve injury occurred in the traction table group, but not in the DRTR group.ConclusionDRTR can safely and effectively provide continuous and stable traction in the femoral shaft fractures surgery, and outperforms the traction table in the number of intraoperative fluoroscopy, opening reduction rate, reduction of complications, and postoperative joint function score.

Genu valgum deformity correction by distal femur translation osteotomy and anterograde intramedullary nailing

Genu valgum deformity correction by distal femur translation osteotomy and anterograde intramedullary nailing

Comparison of the efficacy of small-incision clamp-assisted reduction and open reduction for the treatment of femoral shaft fractures with an anterograde intramedullary nail: a retrospective study

BackgroundTo compare the efficacy of small-incision clamp-assisted reduction with open reduction for the treatment of femoral shaft fractures by anterograde intramedullary nailing.MethodsThe data of 63 patients with femoral shaft fractures, treated between January 2016 and June 2021, were retrospectively analyzed. All patients received anterograde intramedullary nail fixation, and the OA/OTA classification of fractures was 32-C. The average follow-up period was 13 months (range: 11–14 months). According to the method of fracture reduction, patients were divided into a small-incision clamp-reduction group (referred to as the clamp-reduction group) and an open-reduction group. The reduction time, operative time, the number of fluoroscopy, intraoperative blood loss, postoperative VAS score, postoperative time to discharge, and the rates of intraoperative and postoperative complications were compared between the two groups.ResultsThere were statistically significant differences in reduction time, operative time, the number of fluoroscopy, intraoperative blood loss, postoperative VAS score, postoperative time to discharge (t = 6.718, − 11.679, 18.963, − 11.609, − 22.432, − 7.187; P < 0.05). In the clamp-reduction group, there was no intraoperative blood transfusion. However, there were one case of wound infection and one case of deep vein thrombosis after operation. In the open-reduction group, ten patients received intraoperative blood transfusion, one patient developed hemorrhagic shock, two patients developed wound infection, and two patients developed bone nonunion during follow-up.ConclusionsBoth groups had good functional recovery after operation. However, compared with open reduction, clamp reduction is a safer reduction method with shorter operation time, less intraoperative blood loss, less postoperative pain, shorter hospital stay and fewer postoperative complications.

Comparison of third generation long Gamma nail and femur intramedullary nail for the treatment of femoral subtrochanteric fractures

Background/Aim: Internal fixation is the current gold standard procedure in treatment of subtrochanteric femur fractures. One of the most common causes of morbidity after subtrochanteric femoral fracture treatment is mechanical complications, such as implant failure. The aim of this study is to share our experience and compare the radiological and functional results of two different fixation implants in patients with subtrochanteric fractures. Methods: A cohort of 57 patients with a subtrochanteric fracture operated using a third generation Gamma nail (G3LN) or an anterograde intramedullary nail (AIMN) were prospectively followed up. Twenty-eight underwent fracture fixation with the Gamma nail while the other twenty-nine were operated using a conventional AIMN. All patients were followed up until union or, in case of a revision, healing and recovery. Their radiological findings were retrospectively analyzed, and the functional results were assessed using a Harris Hip Score. Results: Data regarding demographic properties such as sex, trauma mechanism and smoking were similar for the subgroups (P 0.05 for each). Compared to the AIMN group, whose reduction was mostly acceptable (48.28%), the majority of G3LN patients (57.14%) had an anatomical reduction on early follow up. Most fractures, regardless of the implant used, needed an open reduction. Both implants showed similar union time and had similar final HHS scores. None of the complication rates reached statistical significance between the two groups (P>0.05 for each). Conclusion: Both third-generation Gamma Nail implant and anterograde intramedullary nailing are viable means of fixation for subtrochanteric hip fractures. They lead to similar and few complications while providing a rigid and secure fixation. These findings lead us to believe that good reduction and adherence to the principles of internal fixation rather than implants used are the key to success in the treatment of subtrochanteric fractures.

EOS stereographic assessment of femoral shaft malunion after intramedullary nailing. A prospective series of 48 patients at 9 months’ follow-up

IntroductionThe aim of the present study was to assess femoral shaft malunion following anterograde intramedullary nailing, using low-dose EOS stereoradiography. The study hypothesis was that our surgical technique is associated with radiological rotation disorder rates equivalent to those reported in the literature. MethodsAll patients with unilateral femoral shaft fracture treated by anterograde nailing between January 2014 and December 2016 and followed up in our structure were included in a single-center prospective study. The main endpoint was≥15° transverse malrotation compared to the contralateral side as measured on EOS stereoradiography. Correlations between malrotation and Harris Hip and SF12 functional scores were assessed, as were risk factors for onset of shaft malunion in rotation. Forty-eight patients with a mean age of 31.4 years were analyzed at a mean 9.3 months’ follow-up. ResultsStereoradiographic malrotation was found in 29.2% of patients. Mean anteversion was 18.5±13.8°. In 2.1% of patients, symptomatic rotation disorder required revision surgery. No correlations emerged between transverse malrotation and functional scores (p>0.05). Risk factors for malrotation comprised multi-site fracture (p=0.04), surgeon's inexperience (p=0.04), and open reduction (p=0.01). ConclusionThe present radiologic malrotation rate was comparable to those reported in the literature, using the EOS stereoradiographic system, which provides precise assessment of rotation disorder following closed nailing of femoral shaft fracture. Level of evidenceIII; prospective study without control group.

Intramedullary femoral nail fixation for A pathological fracture distal to A resurfacing arthroplasty

Traumatic femoral shaft fractures distal to a hip resurfacing arthroplasty (HRA) are rare. Only four cases have been described in which an intramedullary nail was used to treat the fracture. We present the first case in the literature of a pathological femoral shaft fracture distal to a HRA, and describe its treatment with an anterograde intramedullary femoral nail with proximal locking screws placed into the femoral head overlapping the HRA stem. This demonstrates that the presence of a hip resurfacing arthroplasty does not preclude from utilising an intramedullary nail with recon screws to stabilise a pathological fracture.

Multiple Elastic Retrograde Intramedullary Nailing for Adult Humeral Diaphyseal Fractures

The humeral shaft fractures are amenable for conservative treatment as well as external fixation, open reduction and internal fixation, and anterograde or retrograde intramedullary (IM) nailing [1]. IM locked nails have provided excellent outcomes in terms of fracture biology and cosmetic appearance because of the relatively small incision involved.

Clinical and radiographic outcomes after antegrade intramedullary nail fixation of humeral fractures

Humerus fractures are frequent, accounting for about 3-4% of all fractures in adults. Treatment for fractures of the diaphyseal and proximal meta-epiphyseal regions remains controversial: there is no unanimity in the scientific community about the superiority of surgical treatment over non-surgical treatment and which is the best between possible surgical treatments. Among the choices for surgical treatment the most commonly used implants are the locking-compression plate and the intramedullary nailing. The purpose of this study was to perform a clinical and radiographic follow-up in patients who underwent surgical procedures for reduction and osteosynthesis of proximal or diaphyseal humeral fractures by means of anterograde intramedullary nailing with a straight-shaped nail. A clinical and radiographic follow-up was performed in 56 patients who underwent surgical procedures for reduction and osteosynthesis of proximal or diaphyseal humeral fractures by means of antegrade intramedullary nailing using Synthes MultiLoc® system. Clinical data were collected using subjective quality of life assessment forms (SF12-v2), quality of life related to specific disabilities assessment forms (Quick-DASH, ASES score, WORC) and objective functional assessment forms (Constant-Murley score). The radiographic Follow-Up was performed at 30, 90 and 180 days from the date of the surgery. Almost all patients were able to return to a satisfactory quality of life, comparable with the one before the traumatic episode. The functional results were assessed as excellent or good with almost complete recovery of the range of motion and moderate recovery of strength. The residual pain encountered was moderate or zero. The average QuickDASH score was 17.7 ± 4.3 (range 9.1 - 27.3). The average ASES score was 73.8 ± 8.1 (range 58.3 - 88.3). The average WORC score was 543.3 ± 100 [74% ± 4.8%] (range 310 - 740). The mean Constant-Murley score was 69.6 ± 4.6 (range 61 - 84). All patients had a fair or good consolidation of the fracture on radiographic examinations. The calculated RUST score was 4.2 ± 0.4 (range 4-5) 30 days after surgery, 6.1 ± 0.9 (range 4- 8) 90 days after surgery and 9.8 ± 1.5 (range 7-12) to 180 days after surgery. No major complications were found. Treatment of the diaphyseal and proximal meta-epiphyseal humeral fractures with antegrade intramedullary nail provides excellent subjective and objective clinical results and good radiographic results. However, clinical studies with larger number of patients and longer follow-up are necessary.

Definitive Treatment of Femoral Shaft Fractures: Comparison between Anterograde Intramedullary Nailing and Monoaxial External Fixation.

Background: Femoral shaft fractures result from high-energy trauma. Despite intramedullary nailing (IMN) representing the gold standard option of treatment, external fixation (EF) can be used temporarily for damage control or definitively. The purpose of this study is to compare two different options, anterograde IMN and monoaxial EF, for the treatment of femoral shaft fractures. Methods: Between January 2005 and December 2014, patients with femoral shaft fractures operated on in two centers were retrospectively evaluated and divided into two groups: the IMN group (n = 74), and the EF group (n = 73). For each group, sex; laterality; age; and AO classification type mean follow-up, mean union time, and complications were reported. Results: Both groups were found to have no statistical differences (p > 0.05) in sex, laterality, age, and AO classification types. In the IMN group the average surgery duration was 79.7 minutes (range 45–130). The average time for bone union was 26.9 weeks. Major complications occurred in 4 (5.4%) patients. In the EF group the average follow-up duration was 59.8 months (range 28–160). The average time for bone union was 24.0 weeks. Major complications occurred in 16 (21.9%) patients. Conclusions: IMN is the gold standard for definitive treatment of femoral shaft fractures. In patients with severe associated injuries, EF should be a good alternative.

Open Reduction and Olecranon Fossa-Penetrating Anterograde Intramedullary Nailing for the Treatment of Distal Third Humeral Shaft Fractures

Open Reduction and Olecranon Fossa-Penetrating Anterograde Intramedullary Nailing for the Treatment of Distal Third Humeral Shaft Fractures

Risk Assessment of Retrograde Intramedullary Nailing for Proximal Humeral Fracture

In proximal humeral fracture except AO classification 11A1, fixations with a locking plate and nails are recommended. We performed mechanical tests to investigate whether retrograde intramedullary nailing has fixation stability comparable to those of anterograde intramedullary nailing and locking plate which achieve clinically favorable outcomes. In retrograde intramedullary nailing, a nail entry point is made in the diaphysis, for which reduction of stiffness of the humerus is of concern. Thus, we investigated the influence of a nail entry point made in the diaphysis on humeral strength. Retrograde intramedullary nailing had fixation stability against bending and a force loaded in the rotation direction comparable to those of anterograde intramedullary nail and locking plate. Displacement by the main external force loaded on the humerus, compressive load, was less than half in the bone fixed by retrograde intramedullary nailing compared with that in the bone fixed with a locking plate, showing favorable fixation stability. It was clarified that stiffness of the humerus against rotation and a load in the compression direction is not reduced by a nail entry point made by retrograde intramedullary nailing.

Lateral decubitus intramedullary nailing for femoral subtrochanteric fractures

Objective To investigate the efficacy of lateral decubitus intramedullary nailing for treatment of subtrochanteric fractures of the femur. Methods From January 2012 to December 2015, 23 patients with simple femoral subtrochanteric fracture were treated at Department of Orthopedic Trauma, Changhai Hospital. They were 15 males and 8 females, aged from 19 to 77 years (average, 48.3 years). According to the Seinsheimer classification, there were 6 cases of type ⅡB, 8 cases of type ⅡC, 6 cases of type ⅢA, and 3 cases of type ⅢB. Their injuries were caused by traffic accident in 10 cases, falling from a height in 5 cases, and sprain in 8 cases. All patients were treated by closed reduction and anterograde intramedullary nailing at lateral decubitus. Their operative time, bleeding volume, fluoroscopic frequency, fracture healing time, functional recovery and complications were recorded and analyzed. Results Their operative time ranged from 55 to 80 min, averaging 65.7 min; their bleeding volumes ranged from 240 to 420 mL, averaging 304.3 mL; their fluoroscopic frequency ranged from 30 to 60 times, averaging 42.7 times. This cohort was followed up for 12 to28 months (average, 17.9 months). Their fracture healing time ranged from 4 to 10 months, averaging 5.5 months. Nonunion occurred in one patient but was cured by secondary operation. The HSS evaluation at the final follow-ups showed 17 excellent cases and 6 good ones, yielding an excellent to good rate of 100%. All the wounds healed by the first intention. No infection, deep vein thrombosis or implant failure was observed. Conclusion As lateral decubitus intramedullary nailing can achieve satisfactory clinical efficacy for subtrochanteric fractures of the femur, the body position of lateral decubitus may be a good alternative. Key words: Posture; Fracture fixation, intramedullary; Bone nail; Lateral decubitus; Subtrochanteric fracture

Traction table versus double reverse traction repositor in the treatment of femoral shaft fractures

A novel reduction technique of intramedullary nailing (IMN) for femoral shaft fractures was introduced, and in this study, its therapeutic effect was compared with patients treated with the traditional traction table. From November 2012 to August 2015, the patients with femoral shaft fractures fixed with anterograde IMN were reviewed. Seventy-four patients treated with the traction table and forty-eight patients treated with the double reverse traction repositor (DRTR) met the inclusion criteria of this study. The surgical time, blood loss, open reduction rate and complications were reviewed in this study. The fracture healing was assessed by the radiographs conducted at each follow-up. The functional outcome (hip and knee flexion, Harris Hip Score, and Lysholm knee score) was evaluated at the final follow-up. Average surgical time, blood loss, hip and knee flexion, and Harris Hip Score showed no difference (P > 0.05) between the two groups. However, the DRTR was superior to the traction table in fracture healing, Lysholm knee score, open reduction and complications rate (P < 0.05). Thus, we concluded that minimally invasive treatment of femoral shaft fractures could be obtained with the DRTR.

上腕骨骨幹部骨折後の偽関節手術に対し術後合併症を回避し得た1例

We report a case of a patient with a history of surgery for insufficient pseudoarthrosis after a humeral diaphyseal fracture. Although most humeral nonunions are successfully treated with a single procedure, some humeral nonunions are more difficult to heal and require multiple procedures. A-61-year-old man presented at our hospital with pain and deformity in his left upper arm. The humeral diaphyseal fracture had been previously treated elsewhere with open reduction and internal fixation. Some days prior to his visit at our hospital, he had had pain in his left upper arm, without a particular cause, and was admitted to our hospital for initial evaluation. After a complete physical examination, symptoms of infection and any neurovascular deficit were ruled out. Radiographic examination revealed atrophic nonunion of the middle third of the humeral shaft associated with disuse osteopenia. Anterograde intramedullary nailing and bone grafting were performed for the resistant atrophic nonunion of the humeral diaphysis. In addition to the intramedullary nailing, additional fixation was performed for residual rotational instability. A postoperative evaluation revealed a periprosthetic fracture in the distal part of the humerus. Poor bone quality or a deficient plate technique might have lead to the facture. We performed open reduction and internal fixation (ORIF): he underwent fixation with a 2-plate construct for the nonunion of the humeral diaphyseal fracture, together with decortication, debridement, and bone grafting. Eight months after surgery, the patient's bone had healed and he had recovered flexion (110°) and extension (-30°) without complications. An orthopedic surgeon should be aware of these complications when choosing open reduction and internal fixation for the treatment of a history of insufficient pseudoarthrosis. Patients should be closely followed up for evidence of any complications such as infections and malunions. Fracture fixation in patients with pseudoarthrosis requires strategies to overcome the technical difficulties faced during the procedure.

Marchetti Vicenzi elastic retrograde nail in the treatment of humeral shaft fractures: review of the current literature.

Shoulder impairment following anterograde intramedullary nailing for humeral shaft fractures represents a challenging problem for the orthopedic surgeon. Traditional retrograde nailing lowers the rates of shoulder impairment although exposing the surgeons to severe technical issues related to the proximal interlocking. The Marchetti Vicenzi nail (MVN) permits a retrograde insertion along with a self-locking mechanism that lowers the risk of iatrogenic damage during proximal interlocking. Aim of this literature review was to evaluate all the case series dealing with MVN and the obtained results in terms of union rates, complications, and functional outcomes in order to evaluate evidence that would substantiate the adoption of MVN in the treatment of humeral shaft fractures. A search was performed using the keywords "humeral shaft fracture nail," "humeral retrograde nail," "humeral elastic nail," "Marchetti Vicenzi nail," "Marchetti nail," "Vicenzi nail." After accurate revision 13 articles found to be relevant with a total of 532 humeral fractures (traumatic and pathologic) and non-unions treated with MVN. The cumulative healing rate reported is 93.7 % with 6.3 % of non-unions. Despite the fact that obtained results compare favorably to the published data on the outcome of anterograde nailing, the evaluated studies presented a huge number of methodological flaws, thus making it difficult to recommend the adoption of MVN in preference of other better-validated forms of treatment.

Antegrade femoral intramedullary nailing in a lateral position

Intramedullary nailing is the gold standard for the treatment of femoral shaft fractures; however, rotational malalignment remains a common complication. The patient can be positioned on the fracture table in a supine position or alternatively in the lateral decubitus position without any traction. The aim of this article is to describe an effective method to control intraoperative torsion of the femur. The surgical technique described in this article is the standard procedure for femoral shaft fractures and subtrochanteric fractures in this level 1 trauma center. The patient is positioned in a lateral position on a radiolucent table with free draping of the injured leg. Using the C-arm, reduction can be performed with this technique with precise placing of the nails and torsion can be exactly adjusted and controlled with the aid of the femoral neck axis, the distal locking holes and both parallel femoral condyles. The described technique represents an effective method for the intraoperative control of femoral torsion. With an acceptable and most probably clinically irrelevant bias, this technique is able to avoid significant rotational malalignment. It does not prolong the operative procedure and does not require additional navigation settings. It has also been shown to be helpful in the treatment of subtrochanteric fractures. The surgical technique of anterograde intramedullary nailing using the lateral decubitus position without any traction device and free draping of the injured leg represents a safe and reliable treatment concept and offers logistical advantages compared to the supine position of the patient on a fracture table. Together with other described methods of intraoperative torsional control of femoral fractures, the radiological technique described in this study is an easily applicable and safe method, which needs to be confirmed in clinical studies.

A comparison of three operative treatments of distal femoral fractures

Objective To compare anterograde intramedullary nailing (AIN),retrograde intramedullary nailing (RIN) and locking compression plating (LCP) in the treatment of distal femoral fractures.Methods The clinical data were reviewed of 85 patients with distal femoral fractures who had been treated in our department between January 2005 and December 2009.They were 46 males and 39 females,15 to 58 years old (average,38.8 years old).According to the fixation they were divided into 3 groups:AIN (n =17),RIN (n =42) and LCP (n =26).They were compared in terms of operation time,bleeding volume,functional recovery of the knee and complications.Results They were followed for 12 to 24 months (average,18 months).All patients obtained bone union within 6 months except one case of nonunion.In terms of operation time and bleeding volume,AIN and RIN were significantly better than LCP,and AIN significantly better than RIN too (P ＜ 0.05).The good to excellent rate of functional recovery was 58.8％ (10/17) for AIN,88.1％ (37/42) for RIN and 69.2％ (18/26) for LCP; RIN was significantly superior to AIN (P ＜ 0.05).The rate of postoperative complications was 11.8％ (2/17) for AIN,9.5％ (4/42) for RIN and 7.7％ (2/26) for LCP,with no significant between-group difference(P =1.000).Conclusion RIN has advantages of accurate alignment,rigid immobilization,shorter operation time,less bleeding volume,and better functional recovery of the knee over AIN and LCP in the treatment of distal femoral fractures. Key words: Femoral fractures; Fracture fixation, internal; Bone nails; Bone plates