title: Retrograde nailing of femur fractures in patients with myelopathy and who are nonambulatory.
abstract: The authors studied 10 consecutive patients with closed femoral shaft or supracondylar fractures who were nonambulatory and who were treated by reamed retrograde intramedullary nailing via an intercondylar notch approach. The study consisted of five women and five men with an average age of 60.7 years (range, 40-89 years). Six patients had spinal cord lesions, one had a brain injury, one had cerebral palsy, one had multiple sclerosis, and one had progressive myelopathy. Three fractures were supracondylar, and seven fractures involved the mid-distal diaphysis. The average time of surgery was 110 minutes (range, 70-225 minutes) with an average estimated blood loss of 288 mL (range, 150-400 mL). There were two postoperative deaths (at 15 days and 2 months, respectively) after the procedure that were attributable to pneumonia. The remaining eight patients were observed for an average of 13 months (range, 6-20 months) after surgery. All fractures healed as evaluated radiographically. Retrograde intramedullary nailing is a simple, safe, and effective alternative to nonoperative treatment for femoral shaft or supracondylar fractures in patients who are nonambulatory. Stabilization by this method allows fracture healing and rapid return of patients to their previous level of function. There were no nonunions, malunions, significant shortening, implant failure, or wound infections.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: K R
authors.initials: KR
authors.lastname: Chin
authors.forename: D T
authors.initials: DT
authors.lastname: Altman
authors.forename: G T
authors.initials: GT
authors.lastname: Altman
authors.forename: T M
authors.initials: TM
authors.lastname: Mitchell
authors.forename: W W
authors.initials: WW
authors.lastname: Tomford
authors.forename: D W
authors.initials: DW
authors.lastname: Lhowe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D011859:Radiography; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000503:physiopathology*; D015996:Survival Rate