[Retrograde intramedullary nailing of femoral shaft fractures. A prospective study].
OBJECTIVE
Antegrade intramedullary nailing is seen as a most effective method in the management of femoral fractures. However, complications may arise due to the surgical approach.Can these disadvantages be avoided by using a retrograde approach?


METHODS
In a prospective study 70 femoral fractures in 62 patients were stabilised using a long intramedullary nail by a retrograde approach.


RESULTS
We were able to re-examine 50 patients (57 fractures) 13,3 (3-36) months after the operation. Apart from one non-union by infection, all fractures healed in time. Flexion of the knee joint was within a normal ROM in 81% of shaft fractures 12 months or more after the operation, as was the case in 44% of distal fractures. A inhibition of extension was not found in any patient. Two patients had a femoral shortening of up to one centimeter. We observed no rotational malalignment of more than 5 degrees. The clinical results were excellent in 89% of shaft fractures, and in 50% of supra-/diacondylar fractures. In 18 cases a nail removal was already performed, thereby allowing an arthroscopic follow-up inspection of the knee joint. No knee pathology due to nailing was found in either case.


CONCLUSIONS
Our results show the advantages of retrograde intramedullary nailing in comparison to the antegrade method.
Holmenschlager
F
F
Klinik für Unfallchirurgie, Otto-von-Guericke-Universität, Magdeburg. francis.holmenschlager@medizin.uni-magdeburg.de
Piatek
S
S
Halm
J P
JP
Winckler
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D012086:Reoperation