Retrograde Intramedullary Nailing Research Articles

Translated article] Comparative clinical and biomechanical study of different types of osteosynthesis in the treatment of distal femur fractures

Introduction and objectivesDistal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures. Material and methodA clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ2 test were used to evaluate the significance of the different factors, with the condition of P<.05. ResultsIn the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail. ConclusionsOur biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.

Medial and lateral dual plating of native distal femur fractures: a systematic literature review.

Lateral locked plating (LLP) development has improved outcomes for distal femur fractures. However, there is still a modest rate of nonunion in fractures treated with LLP alone, with higher nonunion risk in high-energy fractures, intra-articular involvement, poor bone quality, severe comminution, or bone loss. Several recent studies have demonstrated both the safety and the biomechanical advantage of dual medial and lateral plating (DP). The purpose of this study was to evaluate the clinical outcomes of DP for native distal femoral fractures by performing a systematic review of the literature. Studies reporting clinical outcomes for DP of native distal femur fractures were identified and systematically reviewed. Publications without full-text manuscripts, those solely involving periprosthetic fractures, or fractures other than distal femur fractures were excluded. Fracture type, mean follow-up, open versus closed fracture, number of bone grafting procedures, nonunion, reoperation rates, and complication data were collected. Methodologic study quality was assessed using the Coleman methodology score. The initial electronic review and reverse inclusion protocol identified 1484 publications. After removal of duplicates and abstract review to exclude studies that did not discuss clinical treatment of femur fractures with dual plating, 101 potential manuscripts were identified and manually reviewed. After final review, 12 studies were included in this study. There were 199 fractures with average follow-up time of 13.72 months. Unplanned reoperations and nonunion occurred in 19 (8.5%) and 9 (4.5%) cases, respectively. The most frequently reported complications were superficial infection (n = 6, 3%) and deep infection (n = 5, 2.5%) postoperatively. Other complications included delayed union (n = 6, 3%) not requiring additional surgical treatment and knee stiffness in four patients (2%) necessitating manipulation under anesthesia or lysis of adhesions. The average Coleman score was 50.5 (range 13.5-72), suggesting that included studies were of moderate-to-poor quality. Clinical research interest in DP of distal femoral fractures has markedly increased in the past few decades. The current data suggest that DP of native distal femoral fractures is associated with favorable nonunion and reoperation rates compared with previously published rates associated with LLP alone. In the current review, DP of distal femoral fractures was associated with acceptable rates of complications and generally good functional outcomes. More high-quality, directly comparable research is necessary to validate the conclusions of this review.

Comparison of Dynamic Versus Static Locked Retrograde Tibiotalocalcaneal Arthrodesis With Intramedullary Nail Fixation: Evaluation of the RAIN Database

Hindfoot osteoarthritis (OA) or deformity involving the ankle and subtalar joint is a disabling condition. Tibiotalocalcaneal (TTC) fusion is an effective salvage option in pathologies where total ankle replacement is contraindicated. The purpose of this study is to compare the union rate of the ankle joint in proximal static versus dynamically locked retrograde intramedullary nail fixation for tibiotalocalcaneal arthrodesis. An institutional review board-approved comprehensive chart and radiographic review was performed. TTC arthrodesis performed in patients with OA, post-traumatic arthritis, or deformity corrected by retrograde nail were included. Patients with Charcot arthropathy, failed joint replacement, neuropathy, or avascular necrosis were excluded. The primary outcome was ankle joint union with secondary measure of mean time to fusion. A total of 60 patients met inclusion criteria with 30 in the static group (SG) and 30 in the dynamic group (DG). The average age of the static group (SG) and dynamic group (DG) was 56.9 and 54.1 years, respectively. Mean body mass index was 34.03 kg/m2 for SG and 33.43 kg/m2 for DG. The union rate of the ankle joint was slightly higher in the DG but not statistically significant [SG 83.3%, DG 86.6%, p > .05 (p = .83)]. Time to fusion (TTF) in SG was 111.6 days compared to 97.2 days in DG. Dynamically locked intramedullary nails allow continued compression across the arthrodesis site as fusions remodel. Time to union and union rate of the ankle joint was superior in the dynamic group but this was not statistically significant. In this cohort, union rates were excellent in both groups, and no statistically significant difference was seen in the number of nonunions.

Tibiotalar and Tibiotalocalcaneal Arthrodesis with Paragon28 SilverbackTM Plating System in Patients with Severe Ankle and Hindfoot Deformity

The treatment of end-stage ankle osteoarthritis (OA) and associated hindfoot deformities remains a major challenge for orthopedic surgeons. Numerous techniques and surgical approaches have been proposed for tibiotalar (TT) and tibiotalocalcaneal (TTC) arthrodesis, from arthroscopic to open, as well as numerous devices proposed for internal fixation (retrograde intramedullary nails, cannulated screws, and plating systems). The aim of this study was to retrospectively analyze the results, with at least 18 months of follow-up, with SilverbackTM TT/TTC Plating System Paragon28 in a group of 20 patients with severe OA and hindfoot deformities (mainly secondary post-traumatic OA). The demographic characteristics and past medical history of the patients were collected and analyzed to identify the cause of the pathology. The degree of OA and deformity were quantified based on foot and ankle weight-bearing radiography and CT examination. Pre- and post-operative clinical and functional scores (ROM, VAS, AOFAS, FFI, and SF-36) and radiographic parameters (anterior distal tibial angle, tibiotalar angle, coronal tibiotalar angle, and hindfoot alignment angle) were evaluated. All of the patients showed clinical and radiographic fusion at an average of 14 weeks (range 12-48), with improvement in pain and functional scores, without major surgical complications and/or infections. Despite the limitations of our study, the results with this new plating system showed good results in terms of bone consolidation, post-operative complications, and improvement of pain and quality of life in patients with severe OA and deformities of the ankle and hindfoot.

Revision surgery in comminuted distal one-third femur fracture using retrograde intramedullary nail: A case report

Revision surgery in comminuted distal one-third femur fracture using retrograde intramedullary nail: A case report

Orthogonal plating of distal femur fractures: A biomechanical comparison with plate-nail and parallel plating constructs

PurposeThis study compared the biomechanical properties of orthogonal plating with plate-nail and parallel plating constructs for supracondylar distal femur fractures. MethodsA supracondylar distal femur fracture was simulated using 15 synthetic osteoporotic femurs. Constructs included: (1) plate-nail (lateral locked distal femoral plate + retrograde intramedullary nail); (2) parallel plating (lateral locked distal femoral plate + medial 4.0 mm compression plate); and (3) orthogonal plating (lateral locked distal femoral plate + posterior one-third tubular plate). Specimens underwent nondestructive loading, fatigue loading, and loading to failure. Gapping at the fracture was measured using a three-dimensional motion capture system. Baseline torsional and axial stiffness, stiffness and strain after fatigue loading, and load to failure were determined. A case example of orthogonal plating is also presented. ResultsThere was no difference in baseline torsional (p = 0.51) and axial stiffness (p = 0.53). Stiffness after fatigue loading was highest with parallel plating, with no difference between the plate-nail and orthogonal plating constructs (p = 0.84). Strain after fatigue loading was lowest in the parallel plating group (0.54 ± 0.19%), followed by the plate-nail (2.89 ± 0.83%) and orthogonal plating groups (3.04 ± 0.51%). ConclusionOrthogonal plating demonstrated comparable baseline stiffness to plate-nail and parallel plating constructs, and similar biomechanical performance in fatigue loading to plate-nail constructs. All specimens had ≤3% strain after fatigue loading, suggesting sufficient stability for fracture healing. The benefits of enhanced stability from dual-implant fixation may be achieved through orthogonal plating while avoiding an additional medial surgical approach, and therefore warrants further investigation as a novel alternative for distal femur fracture fixation.

Biomechanical analysis of different fixation methods for Rorabeck II supracondylar femoral fractures after total knee arthroplasty

BackgroundLocking plate (LP) and retrograde intramedullary nailing (RIMN) are widely used to fix Rorabeck II supracondylar femoral fractures after total knee arthroplasty (TKA). The biomechanical properties of the implant used for treatment influence its longevity. Therefore, we aimed to evaluate the biomechanical stability of different fixations using finite element analysis. MethodsSeven finite element models (FEMs) were established, including LP groups (short LP, long LP, and double LP), RIMN groups (short RIMN and long RIMN), and mixed groups (long LP with short RIMN and long LP with long RIMN). The stress of the implants around the fracture area was calculated to evaluate the biomechanical stability under loads. ResultsStress was mainly distributed around the fracture area in all models. The stress-shielding phenomenon was most evident in the short LP. The trend in maximum equivalent stress values of implants around the fracture area for the seven internal fixations was: short LP (324.63 MPa) > short RIMN (306.37 MPa) > long LP (275.06 MPa) > long RIMN (262.74 MPa) > double LP (203.19 MPa) > long LP with short RIMN (124.42 MPa) > long LP with long RIMN (112.41 MPa). We found that the double LP can better disperse the stress than a single LP, and a long LP with long RIMN can prevent stress concentration and make the stress distribution more uniform. ConclusionFrom the perspective of biomechanics, long LP with long RIMN can stabilize fractures and avoid stress concentration in Rorabeck II supracondylar femoral fractures after TKA.

Results of the surgical treatment of intra-articular fractures of the distal femur using a retrograde intramedullary technique

Background: Distal femoral fractures are a widely spread problem in traumatology, which can be caused by both a high-energy trauma and a low-energy trauma in senile patients with osteoporosis. The conservative treatment shows little promise. The surgical treatment of patients is still a challenge for orthopedic surgeons regarding both the technical aspect and a high risk of complications. There are several surgical methods with the use of plates and nails, but there is still no universal conception of the surgical treatment.&#x0D; Aim: comparative analysis of methods of intramedullary retrograde osteosynthesis and bone osteosynthesis in the treatment of fractures of the distal femur.&#x0D; Methods: In this study, we evaluated the treatment results of 46 patients who underwent osteosynthesis for intraarticular fractures of the distal femur using an intramedullary retrograde nail. The evaluation was carried out based on such parameters as the duration of the operation and the time from the moment of injury to the operation, the intraoperative blood loss and the function of the knee joint. On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of the treatment. Reducing the operation time when installing a retrograde intramedullary nail was achieved with a relatively simple technique for installing this type of a fixator and the use of minimally invasive approaches.&#x0D; Results: On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of treatment. Reducing the operation time when installing a retrograde intramedullary nail was due to a relatively simple technique for installing this type of fixator and the use of minimally invasive approaches. One year after the surgery, the following mean values were achieved: 78 (6485) points according to the KSS knee score, 85 (6889) points according to the KSS function score, 3.1 (1.34.2) cm for the severity of pain syndrome according to the VAS scale, 105 (88120) degrees for the flexion in the knee joint. However, a number of post-op complications were observed: deep vein thrombosis of lower extremities was found in 6 (13.1%) patients, formation of a false-joint was seen in 3 (6.5%) patients, 1st grade arthritis of the knee joint was detected in 36 patients (78.2%), 2nd grade arthritis was observed in 10 patients (21.8%). 3rd grade arthritis was not detected. 3.5 years after the operation, none of the patients needed a knee joint replacement.&#x0D; Conclusion: Retrograde intramedullary osteosynthesis in type C distal femoral fractures promotes early rehabilitation, a complete recovery of the knee joint function and healing of the fracture, and represents an effective method of treatment.

Estudio comparativo clínico y biomecánico de distintos tipos de osteosíntesis en el tratamiento de fracturas distales de fémur

Introduction and objectivesDistal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures. Material and methodA clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ2 test were used to evaluate the significance of the different factors, with the condition of P<.05. ResultsIn the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail. ConclusionsOur biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.

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

Abstract&#x0D; Aim&#x0D; 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. &#x0D; Material and Method&#x0D; 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.&#x0D; Results&#x0D; 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). &#x0D; Conclusion&#x0D; 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.

The use of retrograde intramedullary femoral nail for tibiotalocalcaneal fusion in charcot ankle &amp; foot joints

Abstract Introduction Charcot arthropathy is a destructive inflammation, which may affect any joint, especially joints of the ankle and foot. Bony fragmentation, fracture, and dislocation will progress to deformity, bony prominence, and instability. This often causes ulceration and deep infection that may necessitate amputation. The objective of the study is to assess the results of treating Charcot ankle with fusion by retrograde intramedullary femoral nail. Patients and methods Twenty patients were prospectively studied, all of them were clinically diagnosed to have Charcot ankle arthropathy. Preoperative Assessment of all patients by the American Orthopedic Foot and Ankle Scale (AOFAS) was done. In postoperative follow up, the modified AOFAS score was used with a maximum score of 86, as hind foot motion and ankle motion were blocked by arthrodesis. Results Significant improvement in functional score for the series’ patients was encountered. There is increase in the mean score from 33.6 to 73.2 (P&lt;0.001), which considered clinically and statistically significant. Conclusion Tibiotalocalcaneal arthrodesis with retrograde intramedullary nail is a successful method for ankle fusion with good clinical and functional scores.

Tibiotalocalcaneal Arthrodesis: A Retrospective Comparison Between Nails and Lateral Locking Plate Complications.

Tibiotalocalcaneal arthrodesis is a well-established procedure to treat some hindfoot diseases. Currently, the most used implants are retrograde intramedullary nails and locking plates combined with lag screws, but there are few articles comparing differences regarding the complications. We have retrospectively analyzed the medical records and the radiographs of patients older than 18 years who underwent this procedure in our service between 2005 and 2019 through retrograde intramedullary nails or lateral locking plates and compression screws with at least 12 months of follow-up and with no history of osteomyelitis in these bones. We evaluated a total of 67 patients; of these, 48 received retrograde intramedullary nail implants and 19 received locking plates and compression screws. The overall mean age was 48 years; the median follow-up time was 64.3 months. The complication rate was 60.4% for the intramedullary nail procedure and 52.6% for the locking plate combined with compression screws procedure. No significant differences were found in the complication rates between the 2 implants. Level V, Case series.

Evaluation of the Results of Patients Who Have Retrograde Intramedullary Nailing Surgery for Femur Supracondylar Fractures

Introduction: Supracondylar femur fractures are usually seen after high-energy trauma. Our study evaluated the surgical results of patients who underwent retrograde intramedullary nailing surgery. Materials and Methods: Thirty patients were treated with retrograde intramedullary nailing for femoral supracondylar fractures in a single clinic between January 2015 and September 2018. The clinical, functional, and radiological findings were analyzed retrospectively. Demographic data of the patients in our study, length of hospital stay, time until surgery, presence of additional trauma, complication rates, type of trauma, HSS and NEER scoring criteria for functional evaluation, and AO classification were used to determine fracture types. Results: Eighteen (60%) patients had high-energy trauma as the etiological cause, while 12 (40%) had fractures due to low-energy trauma. There were four open fractures and 26 closed fractures in the patients. The patients were evaluated according to the HSS and NEER evaluation systems. According to the HSS scoring system, 8 (26.7%) had excellent, 9 (30%) good, 12 (40%) moderate, and 1 (3%) poor results. According to the NEER scoring system, 7 (23.3%) excellent, 10 (33.3%) good, and 13 (43.4%) intermediate results were obtained. Conclusion: In supracondylar femur fractures, retrograde intramedullary nailing is a method that should be preferred in appropriate cases because of the low amount of bleeding, rapid mobilization, good union since the fracture hematoma is not evacuated, and good postoperative functional results.

ANKLE ARTHRODESIS WITH INTRAMEDULLARY RETROGRADE NAIL FOR BONE TUMORS. PRELIMINARY RESULTS AND SURGICAL TECHNIQUE.

Present the preliminary results of a case series using the surgical ankle arthrodesis technique with an intramedullary retrograde nail for bone tumors. We present the preliminary data of 4 patients, 3 males and 1 female, with a mean age of 46,2 (range 32 to 58) years, with histology proven Giant Cell Tumour of bone in 3 and osteosarcoma in 1. The mean resection length of distal tibia was 11,75 (range 9 to 16) cm, and all the patients underwent reconstruction with a tibiotalocalcaneal arthrodesis with an intercalary allograft fixed by a retrograde intramedullary nail. Oncological follow-up evolved without evidence of local recurrence or disease progression in all patients. After a mean time of 69.5 (range 32 to 98 months), patients had a mean MSTS12 functional score of 82.5% (range 75 to 90). All tibial arthrodesis and diaphyseal osteotomy sites were fused within 6 months with a return to activities without complications related to coverage skin or infection. No complications were recorded; all arthrodesis and diaphysial tibial osteotomy sites fused by 6 months, and the mean follow-up of those patients was 69,5 (range 32 to 988) months, with a mean functional MSTS score of 82,5% (range 75-90). Level of Evidence: IV; Retrospective Case Series.

"Nailable" Does Not Always Mean Reducible in Distal Femur Fractures: Arthroplasty Component and Nail Design Matter.

Distal femur fractures above a total knee arthroplasty (TKA) are challenging. These fractures can be fixed with a retrograde intramedullary nail (rIMN), but the design of the femoral component of the TKA influences the starting point for an rIMN. We performed a biomechanical study to evaluate how different TKA components influence the starting point for an rIMN and how that can lead to a deformity in the sagittal plane. We simulated a distal femur fracture with three different arthroplasty components. We used three different implants to simulate fracture reduction and measured the resultant sagittal plane deformity. Low and moderate femoral component ratio (FCR) design components were able to maintain fracture alignment within 5° of anatomic. High FCR component (more posterior starting point) sagittal plane deformities of up to 15° were observed with both the straight and medium Herzog bend nails, which was statistically significant (P<.001). Use of a high Herzog bend nail decreased the deformity by an average of 6°, which was statistically significant (P<.001). There is variability in how the TKA design affects the starting point and thus the sagittal plane alignment after fixation. This study helps quantify the effect of arthroplasty component design on fracture alignment. [Orthopedics. 2023;46(1):35-38.].

Effectiveness of tibio-talo-calcaneal arthrodesis for Charcot ankle arthropathy: Unraveling the impact of glycated hemoglobin on postoperative recovery and complications

Abstract Background Charcot arthropathy of the ankle is a severe complication of diabetes that can lead to deformity, ulcers, and amputation. Tibio-talo-calcaneal arthrodesis is a surgical technique to stabilize the ankle, but optimal management remains unclear. Objective This study aimed to evaluate the functional and radiological effectiveness of tibio-talo-calcaneal arthrodesis using retrograde intramedullary nailing without bone graft for Charcot ankle and achieve stable aligned ankle construct. Patients and methods In this prospective study, 31 diabetic patients Eichenholtz stages 2–3 (coalescence or reconstruction phases) Charcot ankle underwent tibio-talo-calcaneal arthrodesis with retrograde nail. The American Orthopedic Foot &amp; Ankle Society ankle-hindfoot score measured outcomes at baseline, 6 months, and 12 months postoperatively. Complications were recorded. Regression analysis identified outcome predictors. Results American Orthopedic Foot &amp; Ankle Society scores improved significantly from 17.4 ± 2.37 preoperatively to 73.4 ± 10.5 at 6 months and 81.9 ± 11.5 at 12 months (P&lt;0.001). Twelve (38.7%) patients experienced complications including deep vein thrombosis and sepsis. Elevated glycated hemoglobin predicted complications (odds ratio=3.25, P=0.010) and longer recovery (B=1.353, P=0.008). An glycated hemoglobin cutoff of 8.0% predicted complications with 75.0% sensitivity and 78.9% specificity (area under the curve=0.816). Conclusion Tibio-talo-calcaneal arthrodesis effectively improved ankle function in Charcot arthropathy but complications were common, emphasizing the importance of perioperative glycemic control.

Knee Pain and Functional Outcomes after Retrograde Femoral Nailing: A Retrospective Review.

To investigate the incidence and severity of knee pain following retrograde intramedullary nailing of femur fractures and to better understand functional outcomes using validated patient-reported outcome measures. Fifty-three patients with OTA 32 or 33 fractures treated by retrograde nail at a single academic Level 1 trauma center between 2009 and 2020 were retrospectively reviewed. Patients verbally completed the Oxford Knee Score (OKS) and Patient-Reported Outcome Measurement Information System (PROMIS) Short Form 6b, minimum one year postoperatively. Thirty-four (64%) patients reported the presence of pain. Of those reporting pain, 16 (47.1%) reported their pain as mild. Compared to those without pain, patients with knee pain had lower OKS (30.38 +/- 10.65, versus 41.95 +/- 6.87; P <0.001) and higher PROMIS scores (14.65 +/- 6.76 versus 10.95 +/- 7.09; P=0.066). The increasing severity of pain was inversely correlated with functional status as measured by patient-reported measures. At present, the reliability, high union rates, and otherwise low complication rates associated with retrograde femoral nailing justify its continued use. However, knee pain and functional outcomes should remain an integral part of the preoperative discussion with the patient.

Prospective study of functional outcome of distal femur fracture managed by distal femur nailing

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The purpose of the present study was to assess the functional outcome of distal third femur fracture managed by retrograde intramedullary nailing.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 25 patients with closed distal third femur fracture were enrolled in the study satisfying the inclusion criteria and underwent surgical management with distal femur nailing. Follow up of all the patients was done at 1, 3, 6 and 12 months. The functional outcome of all the operated patients was evaluated by using Lysholm knee scoring system.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In present study 25 cases underwent surgical management with distal femur nailing. After the clinical sign and radiological sign of union, cases were trained with active and passive joint mobilization exercises and functional outcome was evaluated by Lysholm knee scoring system (component-limp, support, pain, instability, locking, swelling, stair climbing, and squatting). The scores were further graded as excellent (&amp;gt;90), good (84-90), fair (65-83) and poor (&amp;lt;65). Out of 25 patient, functional outcome was excellent in 13 (52%), good in 4(13%), fair in 6 (24%) and poor in 2 (8%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The retrograde intramedullary nailing can be considered as a successful, safe reliable, effective and useful technique which should find a place in the armamentarium of every orthop&lt;strong&gt;a&lt;/strong&gt;edic surgeon who deals with distal third femoral fractures.&lt;/p&gt;

Outcomes of surgical management of closed periprosthetic distal femur fractures above total knee arthroplasties: A case series

Periprosthetic distal femur fractures present difficult treatment challenges and are expected to become more prevalent as the number of total knee arthroplasties (TKAs) continues to rise. The purpose of this study is to determine the functional outcomes and rate of re-operation following surgical treatment of closed distal femoral periprosthetic fractures above a TKA. We performed a retrospective review of 56 patients(45 females) who underwent surgical management of distal femur fractures (AO/OTA 33) above an ipsilateral TKA with a mean follow-up of 21 months (range, 12-78 months). Forty-three (77%) patients were treated with a lateral plate and screw construct, and 13 (23%) patients were treated with a retrograde intramedullary nail. There were 2 (4%) deep infections at a mean of 6 months (range, 5-7 months) post-operatively. At final follow-up, TKA components were retained in 53 (93%) patients, demonstrating a survivorship free of component revision following fracture treatment of 93% at 6.5 years. Survivorship free of any re-operation following fracture treatment was 86% at 6.5 years. Mean anatomic lateral distal femoral angle (aLDFA) was 84° (range, 72-89°) and mean anatomic posterior distal femoral angle (aPDFA) was 83° (range, 67-89°). There were 8 nonunions (14%) at 6 month follow-up, and no patients underwent a re-operation for malunion. This case series demonstrates increased revision rates and decreased survivorship of TKA components after surgical management of periprosthetic distal femur fractures. Surgeons must be aware of these potential complications when treating patients with periprosthetic distal femur fractures and counsel their patients appropriately. Therapeutic Level IV. See instructions for all others for a complete description of levels of evidence. • Closed distal femur fractures about a TKA demonstrate a high rate of non-union, 14% at 6-month follow-up. • Following this injury, patients experienced reduced mobility with only 82% being ambulatory after fixation, with 16% still wheelchair bound at 6 months after surgery. • As the number of annual TKA continues to rise, injuries involving those prosthetics will continue to rise.

Comparison of the biomechanical stability of transverse and oblique screw trajectories in retrograde intramedullary nailing of supracondylar femur fractures.

The goal was to determine the effect of addition of oblique trajectory distal interlock screws to a retrograde intramedullary femoral nail on implant stability (stiffness), cycles to failure and mode of failure. The hypothesis was that addition of oblique screws would increase implant stability and number of loading cycles to failure. Eight matched pairs were tested; one femur implanted with a femoral nail with only transverse distal interlock screws and the other with transverse and oblique interlock screws. Axial compressive load was applied to the femoral head and the gluteal tendon was tensioned vertically to simulate standing or at 45° to the sagittal plane to simulate stair climbing. Loads were cycled to increasing amplitude until failure of fixation (10mm displacement or 10° rotation). In simulated standing, oblique screw specimen had greater sagittal bending (bowing) than transverse only specimen. Transverse (axial) plane motion was higher in simulated stair climbing in oblique screw specimen. Oblique screw specimen had higher sagittal plane translation at 600N of load. At 300N, oblique screw specimen had lower internal-external rotation than transverse only specimen. A larger number of cycles to failure were observed in four oblique screw of seven paired specimen. Failure (10mm or 10 degrees of motion) was only achieved during simulated stair climbing. Our hypothesis that adding oblique screws improves fixation was rejected. Activities of daily living other than standing may constitute a challenge to fracture fixation; fixation failure occurred at lower loads in simulated stair climbing than standing.