title: Distal femoral complications following antegrade intramedullary nail placement.
abstract: While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1), nonunion after dynamization with nail penetration into the knee joint (Case #2), and anterior cortical perforation (Case #3). Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature), consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization.
authors: Department of Orthopedic Surgery, Alpert Medical School at Brown University , Providence, RI, USA.
authors: Amanda J
authors: AJ
authors: Fantry
authors: Department of Orthopedic Surgery, Alpert Medical School at Brown University , Providence, RI, USA.
authors: Gregory
authors: G
authors: Elia
authors: Department of Orthopedic Surgery, Alpert Medical School at Brown University , Providence, RI, USA.
authors: Bryan G
authors: BG
authors: Vopat
authors: Department of Orthopedic Surgery, Alpert Medical School at Brown University , Providence, RI, USA.
authors: Alan H
authors: AH
authors: Daniels
keywords: dynamization; femoral cortical perforation; femoral intramedullary nail; fracture nonunion