title: Risk of septic knee following retrograde intramedullary nailing of open and closed femur fractures.
abstract: BACKGROUND
  One potential complication of retrograde femoral nailing in the treatment of femur fractures is the risk of septic knee. This risk theoretically increases in open fractures as a contaminated fracture site has the potential to seed the instrumentation being passed in and out of the sterile intraarticular starting point. There are few studies examining this potential complication in a relatively commonly practiced technique.
  
  
  METHODS
  All patients who received a retrograde femoral nail for femur fracture between September 1996 and November 2006 at a Level 1 trauma center were retrospectively reviewed. This yielded 143 closed fractures, 38 open fractures and 4 closed fractures with an ipsilateral traumatic knee arthrotomy. Patient follow-up records were reviewed for documentation of septic knee via operative notes, wound culture or knee aspirate data, or the administration of antibiotics for suspected septic knee.
  
  
  RESULTS
  No evidence of septic knee was found in the 185 fractures examined in the dataset. Utilizing the Wilson confidence interval, the rate of septic knee based on our population was no greater than 2%, with that of the open fracture group alone being 9%.
  
  
  CONCLUSIONS
  Based on these results and review of the literature, the risk of septic knee in retrograde femoral nailing of both open and closed femoral shaft fractures appears low but potentially not insignificant.
  
  
  BACKGROUND
  There was no outside source of funding from either industry or other organization for this study.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27103, USA. jhalvors@wfubmc.edu
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Halvorson
authors.forename: Marc
authors.initials: M
authors.lastname: Barnett
authors.forename: Ben
authors.initials: B
authors.lastname: Jackson
authors.forename: John P
authors.initials: JP
authors.lastname: Birkedal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000209:etiology*; D001858:Bone Nails / Q000009:adverse effects; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology; D018570:Risk Assessment / Q000379:methods; D055815:Young Adult