title: Analysis of retrograde femoral intramedullary nail placement through traumatic knee arthrotomies.
abstract: OBJECTIVE
  To analyze the rate of postoperative infection after retrograde femoral nail placement in the setting of traumatic knee arthrotomy (KA).
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Level-I trauma center.
  
  
  METHODS
  A review of all adult femur fractures (N = 1748) treated with an intramedullary nail over a 10-year period identified 34 retrograde nails with traumatic KA as the study group and 23 antegrade nails with traumatic KA as a control group. The retrograde femoral traumatic KA group was also compared with a 4:1 matched control group of 136 patients with retrograde femoral nails without traumatic KA.
  
  
  METHODS
  Retrograde femoral nail placement with traumatic KA.
  
  
  METHODS
  Occurrence of postoperative infection.
  
  
  RESULTS
  The traumatic KA groups treated with retrograde and antegrade femoral nails were similar across all recorded patient variables. No infections occurred in the retrograde traumatic KA group versus 1 infection (4.3%) in the antegrade traumatic KA group (P = 0.404). Four nonunions (11.8%) occurred in the retrograde traumatic KA group versus 1 nonunion (4.3%) in the antegrade traumatic KA group (P = 0.638). The matched control group of retrograde nails did not significantly differ when compared with the retrograde traumatic KA group for infection or nonunion (P = 1.000 and 0.261).
  
  
  CONCLUSIONS
  This is the first study to investigate retrograde nail placement through traumatic KA with comparison to control groups, with no differences found in infection rates. Furthermore, no infections (knee or fracture) occurred in those patients who were treated using a retrograde femoral nail with traumatic KA. This study documents the relative safety associated with retrograde femoral nailing in the setting of a concurrent traumatic KA with surgical debridement.
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Nashville, TN 37232-8774, USA.
authors.forename: Jesse E
authors.initials: JE
authors.lastname: Bible
authors.forename: Rishin J
authors.initials: RJ
authors.lastname: Kadakia
authors.forename: Ankeet A
authors.initials: AA
authors.lastname: Choxi
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bauer
authors.forename: Hassan R
authors.initials: HR
authors.lastname: Mir
mesh_terms: D000293:Adolescent; D000328:Adult; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*; D055815:Young Adult