title: Retrograde intramedullary nailing for the treatment of femoral medial condyle fracture nonunion.
abstract: An unicondylar fracture of the femur is uncommon and of the medial condyle more so. Open reduction and internal fixation of these fractures is most commonly performed with screws or plate and screws. Secure bone fixation is compromised by osteoporosis in elderly patients; additional measures may be required. We report the case of an elderly osteoporotic patient with a medial condyle fracture nonunion treated successfully through retrograde intramedullary nailing. A 78-year-old osteoporotic woman suffered medial condyle fracture of the femur 9 months before visiting our hospital. She had been treated conservatively, and the fracture demonstrated a complete nonunion with gross instability. The edge fragments appeared sclerotic, and the nonunion site was accompanied by a bony defect. Although fixation by a plate and screw is the standard method for the treatment of such fracture, we judged that stability would be difficult to achieve with this method due to the accompanying bony defect and osteoporosis. Thus, we performed open reduction and fixation by retrograde intramedullary nailing with the use of "condyle screw and nut" system, followed by bone grafting. Bony union was successfully obtained. The stability and range of motion of the knee were recovered, and the patient regained the ability to walk. We suggest the unique application of retrograde intramedullary nailing with condyle screw and nut for the treatment of specific, complex cases of femoral medial condyle fracture.
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. tniikura@med.kobe-u.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Niikura
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Sang Yang
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Yoshitada
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nishida
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Kuroda
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kurosaka
keywords: Femur; Medial condyle fracture; Nonunion; Retrograde intramedullary nail