Nailing Of Distal Femoral Fractures Research Articles

Analytic study of functional outcome of retrograde intramedullary nailing for distal femoral fractures in adults

<p class="abstract"><strong>Background: </strong>The purpose of this Study was to evaluate the clinical and functional outcome of retrograde intramedullary nailing for distal femur fractures.</p><p class="abstract"><strong>Methods: </strong>This 2 years observational study was done between December 2018 to January 2021, 60 patients with distal femoral fractures were surgically treated at our hospital using retrograde intramedullary nail. The patient was placed supine on fracture table with affected limb flexed to 60 degrees. Through a Transpatellar approach, the nail was introduced in retrograde method after serial reaming. Postoperatively knee range of motion was started immediately and weight bearing was progressed after signs of fracture union were noted on x-rays. The outcome was evaluated for time taken for fracture union, complications and functional outcome with various types of fractures.</p><p class="abstract"><strong>Results: </strong>All the fractures in the present study healed at an average of 13 weeks. However 25 to 40% of these patients underwent bone grafting primarily with reports of delayed union and non-union. Shortening occurred in two patients (3.33%) did affect the final functional outcome. average range of motion is 120 deg. for all fractures, 119 deg. for extra-articular fractures and 118 deg. for intra-articular fractures. Infection rates are low (0% to 8%).</p><p class="abstract"><strong>Conclusions: </strong>The study shows distal femoral fractures were common due to high velocity injuries, retrograde nailing is an excellent technique for management of distal femoral fractures as it promotes high rate of fracture union with less complications.</p>

Factors Affecting Posterior Angulation in Retrograde Intramedullary Nailing for Distal Femoral Fractures

Factors Affecting Posterior Angulation in Retrograde Intramedullary Nailing for Distal Femoral Fractures

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

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.

Clinical results of interlocking Ender nailing for distal femoral fractures

Clinical results of interlocking Ender nailing for distal femoral fractures

Blocking Screws for the Treatment of Distal Femur Fractures

Intramedullary nailing is one of the most convenient biological options for treating distal femoral fractures. Because the distal medulla of the femur is wider than the middle diaphysis and intramedullary nails cannot completely fill the intramedullary canal, intramedullary nailing of distal femoral fractures can be difficult when trying to obtain adequate reduction. Some different methods exist for achieving reduction. The purpose of this study was determine whether the use of blocking screws resolves varus or valgus and translation and recurvatum deformities, which can be encountered in antegrade and retrograde intramedullary nailing. Thirty-four patients with distal femoral fractures underwent intramedullary nailing between January 2005 and June 2011. Fifteen patients treated by intramedullary nailing and blocking screws were included in the study. Six patients had distal diaphyseal fractures and 9 had distal diaphyseo-metaphyseal fractures. Antegrade nailing was performed in 7 patients and retrograde nailing was performed in 8. Reduction during surgery and union during follow-up were achieved in all patients with no significant complications. Mean follow-up was 26.6 months. Mean time to union was 12.6 weeks. The main purpose of using blocking screws is to achieve reduction, but they are also useful for maintaining permanent reduction. When inserting blocking screws, the screws must be placed 1 to 3 cm away from the fracture line to avoid from propagation of the fracture. When applied properly and in an adequate way, blocking screws provide an efficient solution for deformities encountered during intramedullary nailing of distal femur fractures.

Flexible intramedullary nailing for distal femoral fractures in patients with myopathies

Distal femoral fractures are quite common in nonambulating patients with myopathies, as they present marked osteoporosis. The deterioration of preexisting knee flexion contracture is a known problem, as these fractures are usually angulated posteriorly. The goals of treatment are to reduce immobilization and bed rest to a minimum, prevent function loss, and prevent refracture. The aim of our work was to investigate if these goals can be achieved by an operative treatment with closed reduction and flexible intramedullary nailing (FIN). Six distal femoral fractures in four nonambulating patients with myopathies (three Duchenne muscular dystrophy and one nemaline myopathy) were treated with FIN between 2005 and 2011. Patient charts and radiographs were reviewed to determine if intra- or postoperative complications occurred and to detect the interval to wheelchair mobilization and hospital discharge. Pre- and postoperative knee flexion contracture was noted from the patient charts of our reeducation unit, where patients were already known preoperatively. Wheelchair mobilization without further immobilization after an interval of 2-3days was possible. No aggravation of knee flexion contracture was detected in our patient series. No complications associated to the operative treatment itself and no refractures in the follow up occurred. Our experience showed that FIN is a low invasive and sufficiently stable osteosynthesis in such fractures. Left in place, nails will reinforce mechanical stability.

Antegrade Interlocking Nailing for Distal Femoral Fractures

To assess outcomes of antegrade interlocking nailing for supracondylar or intercondylar fractures of the distal femur. Records of 10 women and 20 men aged 20 to 70 (mean, 48.7) years who underwent antegrade interlocking nailing for distal femoral fractures were reviewed. 23 patients had closed fractures and 7 had open fractures; 6 had associated fractures of the forearm or tibia. According to the AO/ASIF system, fractures were classified as types A1 (n=13), A2 (n=6), A3 (n=3), and C1 (n=8). The affected leg was put in an extension shoe for traction, and reduction was achieved with the help of percutaneous lag screws. The nail was inserted from the tip of the greater trochanter and centred in both anteroposterior and lateral planes. The nail was modified to have 3 screw slots in the mediolateral plane and one screw slot in the anteroposterior plane distally for stability in multiple directions. Postoperatively early mobilisation and partial weight bearing were allowed. Patients were assessed using the modified knee-rating scale of the Hospital for Special Surgery. The mean time to bone union was 13.1 (range, 10-18) weeks. The mean follow-up period was 18.8 (range, 11-30) months. Three patients were lost to follow-up; outcomes in the remaining patients were excellent in 20 and good in 7. The mean range of knee flexion was 106 (range, 90-120) degrees. One patient developed a flexion deformity of 10 degrees. All patients attained full quadriceps strength. No patient had ligamentous instability, nerve injuries, superficial or deep infections, or implant failure. Three patients had malunion, which was located in the meta-diaphyseal segment and not in the intraarticular segment. Hence, there was no functional problem or shortening. The mechanical axis was not deviated. Antegrade interlocking nailing achieved good-to-excellent outcomes for distal femoral fractures.

Increasing Nail-Cortical Contact to Increase Fixation Stability and Decrease Implant Strain in Antegrade Locked Nailing of Distal Femoral Fractures: A Biomechanical Study

Proximity of the distal locking screw to the fracture site potentially can cause implant failure in locked nailing of distal femoral fractures. In this biomechanical study, we investigated the effects of nail-cortical contact and nail purchase in the distal subchondral bone on fixation stability and implant strain. Using fiberglass artificial femurs, we fixed five different distal femoral osteotomies with specially manufactured locked nails representing different conditions of nail-cortical contact. In each condition, six femur-nail constructs were loaded on the femoral head axially with 700 N; then we measured the fixation stability and strain at the superiormost distal locking screw and nail hole. The tests were conducted both with and without nail purchase in distal subchondral bone. When there was no nail-cortical contact, the load transmitted to the distal femoral fragment was completely borne by the nail and the distal locking screws. Low fixation stability and high strain on the distal screw and nail hole resulted. Greater nail-cortical contact increased the fixation stability and decreased strains on the distal screw and nail hole. Purchase of the nail tip in distal subchondral bone significantly increased the fixation stability and decreased nail hole strain except in the situation of long nail-cortical contact. The screw strain was significantly reduced in all conditions, and the reduction in strain was significantly greater than that associated with the nail hole, 32% +/- 8% versus 15.7% +/- 2.5% (p = 0.002). In locked nailing of distal femoral fractures, the prime factor determining fixation stability and implant strain is nail-cortical contact. In situations without nail-cortical contact, a longer nail with purchase in the subchondral bone of the distal femur is recommended.

Limb Malalignment and Functional Outcome After Antegrade Versus Retrograde Intramedullary Nailing in Distal Femoral Fractures

Torsional malalignment and mechanical axis deviation (MAD) are worrisome complications after nailing of distal femoral fractures. Variable, sometimes contradictory, reports about these problems have been published. In a retrospective nonrandomized study, 41 patients (mean age, 44.5 years) with distal third femoral fractures that were operatively treated using either antegrade (20 cases) or retrograde (21 cases) intramedullary nailing during a period of 2 years have been reviewed. Goniometric measurement was done using a navigated ultrasound examination whereas functional evaluation and return to sports were assessed using Merle d'Aubigné functional grading system and Tegner and Lysholm activity score. There was no difference in femoral length, torsion, or MAD between patients treated using antegrade nails and those treated with a retrograde nail. There was a greater limitation of knee motion with retrograde nailing and of hip motion with antegrade nailing. The functional grading and activity evaluation showed, however, no difference between both groups. The study cohort showed that no treatment method had proved an advantage over the other regarding limb geometry or the functional outcome. The proper operative indication, intraoperative control, and the surgeon's experience seem to be more important in this regard than the nailing technique.

The retrograde intramedullary supracondylar nail: an alternative in the treatment of distal femoral fractures in the elderly?

To find out whether retrograde nailing of distal femoral fractures is beneficial for the aged patient, we performed a prospective study of consecutive patients 65 years or older with distal femoral fracture treated with a retrograde femoral nail between 1 March 1993 and 30 April 1996 in our department. In total, 26 patients with unilateral distal femoral fractures had been treated in our department, and 24 patients had been followed up for more than 12 months. All fractures had healed. Six patients did not walk before the injury. According to the Neerscore we counted 10/18 excellent results (> or = 85 points), 6/18 good results (> or = 70 points), 2/18 fair results (> or = 55 points) and no failures (< 55 points). Retrograde intramedullary nailing makes a biological osteosynthesis of distal femoral fractures possible. Even in our aged patients good functional results could be obtained. Poor hold of the distal interlocking screws and difficult proximal locking are the two major technical problems encountered with this implant. Early weight-bearing is not advisable.

The retrograde intramedullary nail: prospective experience in patients older than sixty-five years.

To determine whether retrograde nailing of distal femoral fractures is beneficial for the elderly patient. Prospective study of consecutive patients, aged sixty-five years or older, whose distal femoral fractures were treated with a retrograde femoral nail between January 3, 1993, and April 30, 1996. Twenty-four of twenty-six patients were followed for more than twelve months. There were twenty AO/ASIF 33A and four AO/ASIF 33C fractures. Twenty-three were closed. There was one Gustilo type 1 fracture. All fractures healed. Six patients did not walk before injury. Using the Neer scoring system, there were ten (56 percent) excellent (85 or more points), six (33 percent) good (70 or more points), and two (11 percent) fair (55 or more points) results; none of the cases were considered as failures (less than 55 points). Retrograde intramedullary nailing makes possible a biological osteosynthesis of distal femoral fractures. It also produces good functional results in elderly patients. The two major technical problems encountered with this implant are the poor hold of the distal interlocking screws and difficulties with proximal interlocking. Early weight-bearing is not advisable.

Treatment of distal femoral fractures in the elderly. Results with the retrograde intramedullary supracondylar nail.

The drawbacks of plating techniques for the treatment of distal femoral fractures are the need for a large exposure with the possible risk of soft tissue damage, devascularisation of bone fragments and loss of the possible positive effect of the fracture hematoma. Moreover, early weight bearing is not advisable with these implants. To find out whether the retrograde nailing of distal femoral fractures is beneficial we performed this study. Between March 1, 1993 and September 1, 1995, 25 patients with 26 distal femoral fractures were treated in our department with retrograde femoral nailing. According to the ASIF-classification we classified 20 fractures as supracondylar A fractures and 6 fractures as intercondylar C fractures. All fractures were closed and without important soft tissue damage. One patient dies of a not fracture-related cause before fracture healing was achieved. Twenty-five fractures healed. According to our relative Neer-score we counted 18/25 (72%) excellent results (> or = 85 points), 5/25 (20%) good results (> or = 70 points), 1 (4%) fair result (> or = 55 points and 1 (4%) bad result (< 55 points). The retrograde intramedullary nailing makes a biological osteosynthesis of distal femoral fractures possible. Also in our aged patients good functional results could be obtained. Poor hold of the distal interlocking screws and difficult interlocking are the 2 major technical problems encountered with this implant. Early weight bearing is not advisable.

Retrograde nailing for distal femoral fractures in Paget's disease

Retrograde nailing for distal femoral fractures in Paget's disease

Intramedullary locked nailing for distal femoral fractures

Surgical Principles Distal femoral fractures, supracondylar and condylar fractures which can be successfully reduced by closed methods are treated with a modified method of intramedullary locked nails. Closed reduction is obtained by adducting the distal fragment and by adjusting the degree of knee flexion and extension. Condylar fractures, if present, are reduced closed and fixed with percutaneous lag screws. After preparing the medullary cavity, the distal 15 mm of the locked nail is cut away and the tip of the nail is driven to the subchondral bone of the distal femur. The advantage of this technique is the minimal dissection for these difficult fractures. The splinting effect of the intramedullary nail decreases the incidence of refracture in the geriatric patient in whom refractures are relatively common. However, this technique may not be applicable in very distal fracture and condylar fracture which cannot be reduced by closed methods, and condylar fracture in the sagittal plane.