Retrograde fixation of distal femoral fractures: results using a new nail system

Abstract

Objectives: To investigate the management and outcome of distal femur fractures treated with retrograde nailing.

Design: Prospective.

Setting: Unfallkrankenhaus Berlin, level I trauma center.

Patients: A consecutive series of 47 patients with 48 fractures of the distal femur (37 fractures AO type A and 11 fractures type C) operated on between May 1999 and June 2000.

Outcome measures: Outcome was assessed by using standard radiographic criteria of time to union, incidence of infection, malunion, and knee function (Leung score).

Results: After an average time of 33 months (range 12-37 months), 44 patients were reexamined. Three patients were lost to follow-up. The average age was 44 years (range 17-92 years). Of patients, 19 sustained polytrauma, and 10 had associated soft tissue damage. A total of 34 patients underwent primary definitive osteosynthesis within 12 hours after trauma. All fractures healed after an average of 12.6 weeks (range 9-17 weeks). Seven complications were noted-three related to severity of injury (one deep venous thrombosis, two leg length shortenings of 1.5 cm and 2.5 cm) and four related to the operation (insufficient counterboring of the nail in two patients, one malreduction, one iatrogenic fracture of femur shaft). There was no relevant difference between type A and type C fractures in functional, clinical, or radiographic outcomes.

Conclusions: Retrograde nailing is recommended as an alternative method to plate osteosynthesis in stabilizing distal femoral fractures, particularly in type C fractures.