Retrograde intramedullary nailing for the treatment of shaft and distal third femoral fractures
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Published:
Jan 22, 2015
Keywords:
Femoral supracondylar fracture, Polytrauma, Retrograde intramedullary nailing
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Abstract
Background: The purpose of this study was to analyze the results of retrograde interlocking intramedullary nailing in patients with multiple injuries, obese, and >65 years old, who had suffered fractures of the shaft and distal third of the femur.Methods: Twenty-one fractures were treated from 2002 to 2009, with an average follow-up of 27 months. Two patients were excluded because they were lost in the follow-up. There were 10 patients with multiple injuries and 5 obese patients. Twelve of the 19 patients were >65 years old. Surgery was performed in the fluoroscopy standard table using the intercondylar notch approach.Results: Eighteen patients achieved bone healing within 4 to 6 months. A patient had a delayed consolidation, and a new surgery to exchange the nail was required for healing the fracture. There were no infections. Sixteen patients (84.21%) recovered their normal activities.Conclusions: The retrograde interlocking intramedullary nailing is a good treatment option for patients with multiple injuries, obese and >65 years, who had suffered fractures of the shaft and distal third of the femur. Longer follow-up is required to determine the adverse effect of this technique on the function of the patellofemoral joint.
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Plos, J. L. (2015). Retrograde intramedullary nailing for the treatment of shaft and distal third femoral fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 80(1), 35-42. https://doi.org/10.15417/347
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Clinical Research
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References
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Long-term effects of static interlocking fixation. J Bone Joint Surg Am 1992;74(1):106-12.
2. King KF, Rush J. Closed intramedullary nailing of femoral shaft fractures. A review of one hundred and twelve cases treated by
the Kuntscher technique. J Bone Joint Surg Am 1981;63(10):1319-23.
3. Küntscher GB. The Küntscher method of intramedullary fixation. J Bone Joint Surg Am 1958;40(1):17-26.
4. Ricci W, Gallagher B, Haidukewych G. Intramedullary nailing of fractures: current concepts. J Am Acad Orthop Surg
2009;17(5):296-305.
5. Winquist RA, Hansen ST Jr, Kay Clawson D. Closed intramedullary nailing of femoral fracture: A report of five hundred and
twenty cases. J Bone Joint Surg Am 1984;83(12):529-39.
6. Bone LB, Johnson KD, Weigelt J, Schienberg R. Early versus delayed stabilization of femoral fractures: A prospective
randomized study. J Bone Joint Surg Am 1989;71(3):336-40.
7. Gorosito I, Olivetto R, Bruchmann G, Gonzalez S. Fracturas supracondíleas del fémur: clavos endomedulares retrógrados. Rev
Asoc Ortop Traumatol 1999;64(1):19-22.
8. Gregory P, DiCicco J, Karpik J, Kevin M. Ipsilateral fractures of the femur and tibia: Treatment with retrograde femoral
nailing and unreamed tibial nailing. J Orthop Trauma 1996;10(5):309-16.
9. Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal
injuries: Effect of early operative stabilization of fractures. J Trauma 1985;25(5):375–84.
10. Letts RM, Doermer E. Conversation in the operating theater as a cause of airborne bacterial contamination. J Bone Joint Surg
Am 1983;65(3):357-62.
11. Pape HC, Grimme K, Van Griensven M. Impact of intramedullary instrumentation versus damage control for femoral fractures
on immunoinflammatory parameters: Prospective randomized analysis by the EPOFF Study Group. J Trauma 2003;55(1):7-13.
12. Riina J, Tornetta P III, Ritter C, Geller J. Neurologic and vascular structures at risk during anterior-posterior locking of
retrograde femoral nails. J Orthop Trauma 1998;12(6):379-81.
13. Tucker MC, Schwappach JR, Leighton RK. Results of femoral intramedullary nailing in patients who are obese versus those
who are not obese: A prospective multicentecomparison study. J Orthop Trauma 2008;22(3):S14-S20.
14. Wolinsky PR, McCarty EC, Shyr Y, Johnson Kenneth D. Length of operative procedures: Reamed femoral intramedullary
nailing performed with and without a fracture table. J Orthop Trauma 1998;12(7):485–95.
15. Küntscher GB. Weitere Forstchritte auf dem Giebet der Marknagelung. Langenbecks Arch Chir 1966;316:224-31.
16. Küntscher G. A new method of treatment of pertrochanteric fractures. Proc Roy Soc Med 1970;63(11 Part 1):1120-1.
17. Ender HG. Fixation Trochanterer Bruche mit Federnägln nach Ender und Simon-Weidner. Langenbecks Arch Chir
1973;334:935.
18. Iannacone WM, Bennett FS, DeLong WG, Born CT, Dalsey RM. Initial experience with the treatment of supracondylar
femoral fractures using the supracondylar intramedullary nail: a preliminary report. J Orthop Trauma 1994;8(4):322-7.
19. Patterson BM, Routt MLC Jr, Benirschke SK, Hansen ST. Retrograde nailing of femoral shaft fractures. J Trauma
1995;38(1):38–43.
20. Sander R, Koval KJ, Dipasquale T, Helfet DL, Frankle M. Retrograde reamed femoral nailing. J Orthop Trauma 1993;
7:293-302.
21. Swiontkowski MF, Hansen ST, Kellan J. Ipsilateral fracture of the femoral shaft. A treatment protocol. J Bone Joint Surg Am
1984;66(2):260-8.
22. Moed BR, Watson JT. Retrograde intramedullary nailing, without reaming, of fractures of the femoral shaft in multiply injured
patients. J Bone Joint Surg Am 1995;77(10):1520-7.
23. Krupp RJ, Malkani AL, Goodinn LA, Voor MJ. Optimal entry point for retrograde nailing. J Orthop Trauma 2003;17(2):
100-5.
24. Moed Br, Watson JT, Cramer KE, Karges D E, Teefey JS. Unreamed retrograde intramedullary nailing for the fractures of the
femoral shaft. J Orthop Trauma 1998;12(5):334-42.
25. Ostrum RF. Treatment of floating knee injuries through a single percutaneous approach. Clin Orthop 2000;(375):43–50.
26. Ostrum RF, Maurer JP. Distal third femur fractures treated with retrograde femoral nailing and block screws. J Orthop Trauma
2009;23(9):681-4.
27. Ricci WM, Bellabarba C, Evanoff B, Herscovici D, Di Pasquale T, Sander R. Retrograde versus antegrade nailing of femoral
shaft fractures. J Orthop Trauma 2001;15(3-4):161-9.
28. Lundy DW, Johnson KD. “Floating knee” injuries: ipsilateral fractures of the femur and tibia. J Am Acad Orthop Surg 2001;
9(7-8):238-45.
29. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones:
retrospective and prospective analyses. J Bone Joint Surg Am 1976;58(6):453-8.
30. Gustilo RB, Merkow RL, Templeman D. The management of open fractures. J Bone Joint Surg Am 1990;72(2):299-304.
31. Sociedad Argentina de Infectología. Guía para la profilaxis antibiótica prequirúrgica. Agosto 2003.
32. Charnley J. Postoperative infection after total hip replacement with special reference to air contamination in the operating room.
Clin Orthop 1972;(87):167-87.
33. Fletcher N, Sofianos D, Brantling B, Willams T. Prevention of perioperative infection. J Bone Joint Surg Am 2007;89(7):
1605-18.
34. Hanssen AD, Osmon DR, Nelson CL. Prevention of deep periprosthetic joint infection. Instr Course Lect 1997;46(3):555-67.
35. Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect
1999;48:111-22.
36. Ostrum ME, DiCicco RF, McElroy J, Poka A. Effects of retrograde femoral intramedullary nailing on the patellofemoral
articulation. J Orthop Trauma 1999;13(1):13-6.
37. Pape HC, Dwenger A, Regel G. Pulmonary damage after intramedullary femoral nailing in traumatized sheep: Is there an effect
from different nailing methods? J Trauma 1999;33(4):574-81.
38. Pape HC, Tornetta P III, Tarkin I, Tzioupis C, Vani S, Steven A. Timing of fracture fixation in multitrauma patients: the role
of early total care and damage control surgery. J Am Acad Orthop Surg 2009;17(9):541-9.
39. Rio M, Patricios S, Saa J. Lesiones producidas en la rodilla durante el enclavado endomedular retrógrado del fémur. Estudio
experimental en rodillas cadavéricas. Rev Asoc Argent Ortop Traumatol 2009;74(2):148-51.
Long-term effects of static interlocking fixation. J Bone Joint Surg Am 1992;74(1):106-12.
2. King KF, Rush J. Closed intramedullary nailing of femoral shaft fractures. A review of one hundred and twelve cases treated by
the Kuntscher technique. J Bone Joint Surg Am 1981;63(10):1319-23.
3. Küntscher GB. The Küntscher method of intramedullary fixation. J Bone Joint Surg Am 1958;40(1):17-26.
4. Ricci W, Gallagher B, Haidukewych G. Intramedullary nailing of fractures: current concepts. J Am Acad Orthop Surg
2009;17(5):296-305.
5. Winquist RA, Hansen ST Jr, Kay Clawson D. Closed intramedullary nailing of femoral fracture: A report of five hundred and
twenty cases. J Bone Joint Surg Am 1984;83(12):529-39.
6. Bone LB, Johnson KD, Weigelt J, Schienberg R. Early versus delayed stabilization of femoral fractures: A prospective
randomized study. J Bone Joint Surg Am 1989;71(3):336-40.
7. Gorosito I, Olivetto R, Bruchmann G, Gonzalez S. Fracturas supracondíleas del fémur: clavos endomedulares retrógrados. Rev
Asoc Ortop Traumatol 1999;64(1):19-22.
8. Gregory P, DiCicco J, Karpik J, Kevin M. Ipsilateral fractures of the femur and tibia: Treatment with retrograde femoral
nailing and unreamed tibial nailing. J Orthop Trauma 1996;10(5):309-16.
9. Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal
injuries: Effect of early operative stabilization of fractures. J Trauma 1985;25(5):375–84.
10. Letts RM, Doermer E. Conversation in the operating theater as a cause of airborne bacterial contamination. J Bone Joint Surg
Am 1983;65(3):357-62.
11. Pape HC, Grimme K, Van Griensven M. Impact of intramedullary instrumentation versus damage control for femoral fractures
on immunoinflammatory parameters: Prospective randomized analysis by the EPOFF Study Group. J Trauma 2003;55(1):7-13.
12. Riina J, Tornetta P III, Ritter C, Geller J. Neurologic and vascular structures at risk during anterior-posterior locking of
retrograde femoral nails. J Orthop Trauma 1998;12(6):379-81.
13. Tucker MC, Schwappach JR, Leighton RK. Results of femoral intramedullary nailing in patients who are obese versus those
who are not obese: A prospective multicentecomparison study. J Orthop Trauma 2008;22(3):S14-S20.
14. Wolinsky PR, McCarty EC, Shyr Y, Johnson Kenneth D. Length of operative procedures: Reamed femoral intramedullary
nailing performed with and without a fracture table. J Orthop Trauma 1998;12(7):485–95.
15. Küntscher GB. Weitere Forstchritte auf dem Giebet der Marknagelung. Langenbecks Arch Chir 1966;316:224-31.
16. Küntscher G. A new method of treatment of pertrochanteric fractures. Proc Roy Soc Med 1970;63(11 Part 1):1120-1.
17. Ender HG. Fixation Trochanterer Bruche mit Federnägln nach Ender und Simon-Weidner. Langenbecks Arch Chir
1973;334:935.
18. Iannacone WM, Bennett FS, DeLong WG, Born CT, Dalsey RM. Initial experience with the treatment of supracondylar
femoral fractures using the supracondylar intramedullary nail: a preliminary report. J Orthop Trauma 1994;8(4):322-7.
19. Patterson BM, Routt MLC Jr, Benirschke SK, Hansen ST. Retrograde nailing of femoral shaft fractures. J Trauma
1995;38(1):38–43.
20. Sander R, Koval KJ, Dipasquale T, Helfet DL, Frankle M. Retrograde reamed femoral nailing. J Orthop Trauma 1993;
7:293-302.
21. Swiontkowski MF, Hansen ST, Kellan J. Ipsilateral fracture of the femoral shaft. A treatment protocol. J Bone Joint Surg Am
1984;66(2):260-8.
22. Moed BR, Watson JT. Retrograde intramedullary nailing, without reaming, of fractures of the femoral shaft in multiply injured
patients. J Bone Joint Surg Am 1995;77(10):1520-7.
23. Krupp RJ, Malkani AL, Goodinn LA, Voor MJ. Optimal entry point for retrograde nailing. J Orthop Trauma 2003;17(2):
100-5.
24. Moed Br, Watson JT, Cramer KE, Karges D E, Teefey JS. Unreamed retrograde intramedullary nailing for the fractures of the
femoral shaft. J Orthop Trauma 1998;12(5):334-42.
25. Ostrum RF. Treatment of floating knee injuries through a single percutaneous approach. Clin Orthop 2000;(375):43–50.
26. Ostrum RF, Maurer JP. Distal third femur fractures treated with retrograde femoral nailing and block screws. J Orthop Trauma
2009;23(9):681-4.
27. Ricci WM, Bellabarba C, Evanoff B, Herscovici D, Di Pasquale T, Sander R. Retrograde versus antegrade nailing of femoral
shaft fractures. J Orthop Trauma 2001;15(3-4):161-9.
28. Lundy DW, Johnson KD. “Floating knee” injuries: ipsilateral fractures of the femur and tibia. J Am Acad Orthop Surg 2001;
9(7-8):238-45.
29. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones:
retrospective and prospective analyses. J Bone Joint Surg Am 1976;58(6):453-8.
30. Gustilo RB, Merkow RL, Templeman D. The management of open fractures. J Bone Joint Surg Am 1990;72(2):299-304.
31. Sociedad Argentina de Infectología. Guía para la profilaxis antibiótica prequirúrgica. Agosto 2003.
32. Charnley J. Postoperative infection after total hip replacement with special reference to air contamination in the operating room.
Clin Orthop 1972;(87):167-87.
33. Fletcher N, Sofianos D, Brantling B, Willams T. Prevention of perioperative infection. J Bone Joint Surg Am 2007;89(7):
1605-18.
34. Hanssen AD, Osmon DR, Nelson CL. Prevention of deep periprosthetic joint infection. Instr Course Lect 1997;46(3):555-67.
35. Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect
1999;48:111-22.
36. Ostrum ME, DiCicco RF, McElroy J, Poka A. Effects of retrograde femoral intramedullary nailing on the patellofemoral
articulation. J Orthop Trauma 1999;13(1):13-6.
37. Pape HC, Dwenger A, Regel G. Pulmonary damage after intramedullary femoral nailing in traumatized sheep: Is there an effect
from different nailing methods? J Trauma 1999;33(4):574-81.
38. Pape HC, Tornetta P III, Tarkin I, Tzioupis C, Vani S, Steven A. Timing of fracture fixation in multitrauma patients: the role
of early total care and damage control surgery. J Am Acad Orthop Surg 2009;17(9):541-9.
39. Rio M, Patricios S, Saa J. Lesiones producidas en la rodilla durante el enclavado endomedular retrógrado del fémur. Estudio
experimental en rodillas cadavéricas. Rev Asoc Argent Ortop Traumatol 2009;74(2):148-51.