title: Retrograde reamed femoral nailing.
abstract: Closed, reamed, antegrade nailing remains the standard of care for femoral shaft fractures. This technique however, may be less attractive in the management of femoral shaft fractures associated with (a) ipsilateral acetabular, pelvis, or femoral neck fractures; (b) poly trauma requiring multiple simultaneous surgical procedures; and (c) pregnancy. We now report on our experience with the retrograde femoral nailing as a treatment option in these situations. Between 4/88 and 10/90, 29 retrograde femoral nailing in 24 patients were attempted. Average age was 29.3 (16-74) years. Five fractures were open. Fracture location was isthmal in 14 and infraisthmal in 15. The comminution was classified according to Winquist and Hansen: I(10), II(7), III(7), and IV(5). Nailing was possible in 28/29 cases. Insertion was made through an extraarticular medial condylar portal. Nail diameter ranged from 10 to 13 mm. An AO Universal Femoral Nail was used in the first 11 cases; all subsequent fractures were stabilized using an AO Universal Tibial Nail because its design appeared better suited to this technique. Follow-up was possible for 25 fractures in 21 patients and averaged 16.0 (range, 11-27); months 23/25 (92%) fractures healed within 12 weeks. No case was associated with an infection, loss of reduction, or nail failure. Knee flexion averaged 122°; only two knees had an extensor lag of >5°. Intraoperative complications included three cases of crack propagation at the insertion site, and four infraisthmal malreductions (two valgus, two flexion). Based on these results, we feel that retrograde reamed femoral nailing is a suitable alternative to antegrade nailing and should be considered in situations where proximal access is neither possible nor desirable.
authors.affiliation: Orthopedic Trauma Service, Tampa General Hospital, Tampa Florida; *Fracture Service, The Hospital for Joint Diseases, Orthopaedic Institute, New York, New York; †Laboratory for Experimental Research, Davos, Switzerland; and ‡Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Roy
authors.initials: R
authors.lastname: Sanders
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Koval
authors.forename: Thomas
authors.initials: T
authors.lastname: DiPasquale
authors.forename: David L
authors.initials: DL
authors.lastname: Helfe
authors.forename: Mark
authors.initials: M
authors.lastname: Frankle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005265:Femoral Neck Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D055815:Young Adult