title: Limb malalignment and functional outcome after antegrade versus retrograde intramedullary nailing in distal femoral fractures.
abstract: BACKGROUND
  Torsional malalignment and mechanical axis deviation (MAD) are worrisome complications after nailing of distal femoral fractures. Variable, sometimes contradictory, reports about these problems have been published.
  
  
  METHODS
  In a retrospective nonrandomized study, 41 patients (mean age, 44.5 years) with distal third femoral fractures that were operatively treated using either antegrade (20 cases) or retrograde (21 cases) intramedullary nailing during a period of 2 years have been reviewed. Goniometric measurement was done using a navigated ultrasound examination whereas functional evaluation and return to sports were assessed using Merle d'Aubigné functional grading system and Tegner and Lysholm activity score.
  
  
  RESULTS
  There was no difference in femoral length, torsion, or MAD between patients treated using antegrade nails and those treated with a retrograde nail. There was a greater limitation of knee motion with retrograde nailing and of hip motion with antegrade nailing. The functional grading and activity evaluation showed, however, no difference between both groups.
  
  
  CONCLUSIONS
  The study cohort showed that no treatment method had proved an advantage over the other regarding limb geometry or the functional outcome. The proper operative indication, intraoperative control, and the surgeon's experience seem to be more important in this regard than the nailing technique.
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, University of Ulm, Ulm, Germany.
authors.forename: Khaled Hamed
authors.initials: KH
authors.lastname: Salem
authors.forename: Dirk
authors.initials: D
authors.lastname: Maier
authors.forename: Peter
authors.initials: P
authors.lastname: Keppler
authors.forename: Lothar
authors.initials: L
authors.lastname: Kinzl
authors.forename: Florian
authors.initials: F
authors.lastname: Gebhard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000534:rehabilitation / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000295:instrumentation; D017759:Fractures, Malunited / Q000209:etiology*; D006621:Hip Joint; D006801:Humans; D007719:Knee Joint; D007870:Leg Length Inequality / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D014102:Torsion Abnormality