Factors Affecting Posterior Angulation in Retrograde Intramedullary Nailing for Distal Femoral Fractures

PURPOSE: To analyze the factors that cause a posterior angulatory deformity in the retrograde intramedullary nailing of distal femoral fractures. MATERIALS AND METHODS: Fifty-five patients with distal femur fractures who were treated with retrograde intramedullary nailing were enrolled in this study. They were followed-up for at least one year postoperatively. The posterior angulatory deformity was evaluated according to the fracture location, pattern, and insertion point and the insertion point was compared with the ideal point derived from the radiographs of 100 normal adults. The correlation between the posterior angulation and the entry point of the nail was analyzed. RESULTS: The posterior angulation was similar in terms of the fracture location; a meaningful difference was noted among the fracture patterns (p=0.047). The posterior angulation was significantly greater when the entry point was located more posteriorly, accepting a malreduced state (p=0.012). CONCLUSION: Posterior angulation was smaller in the transverse fracture and the posterior location of the entry point from the apex of the Blumensaat's line increased the posterior angulation.

Treatment of Periprosthetic Femoral Fractures Following Total Knee Arthroplasty

PURPOSE: The purpose of this study is to compare the treatment results of fracture fixations by using two minimal invasive techniques for patients with periprosthetic femoral fractures following total knee arthroplasty. MATERIALS AND METHODS: We reviewed 36 patients (5 males, 31 females) of periprosthetic femoral fractures whom were treated surgically between January 2005 and January 2011. Mean patient age was 68.9 years (range, 43 to 81 years) old and the follow-up period averaged 41 months (range, 18 to 72 months). Nineteen patients were treated with minimal invasive locking plate fixations (group I) and 17 patients with retrograde intramedullary nailing (group II). Clinical and radiological outcomes in each group were comparatively analyzed. RESULTS: Successful bone unions occurred in all patients and the mean time to bone union was 3.7 months in group I and 4.2 months in group II. There were no statistical differences between the two groups according to mean operative time and mean intraoperative blood loss. There were also no statistical differences between two groups according to clinical outcomes but the valgus deformity was apparent in group II and radiological outcomes revealed significant differences between the two groups. CONCLUSION: For the treatment of periprosthetic femoral fractures after total knee arthroplasty, two minimal invasive techniques have shown good clinical results. However, the minimal invasive plate fixation showed better results in the radiological alignments.

Treatment for Periprosthetic Supracondylar Femur Fractures Following Total Knee Arthroplasty -Comparative Study of Retrograde Intramedullary Nailing and Locking Compression Plate Fixation-

PURPOSE: The purpose of this research is to compare the clinical and radiological results of retrograde intramedullary nailing and locking compression plate fixation. Both of these are surgical procedures for the treatment of periprosthetic supracondylar femur fractures that occur subsequent to total knee arthroplasty. MATERIALS AND METHODS: The subject population consisted of 23 cases: there were 10 cases that underwent retrograde intramedullary nailing fixation (group 1) and 13 cases that underwent use of a locking compression plate (group 2), and in both groups supracondylar femur fracture subsequent to total knee replacement occurred during the period between January 2004 and December 2008. The range of joint motion, the Hospital for Special Surgery (HSS) knee score, the tibio-femoral angle and the time to achieve bone union in each group were comparatively analyzed. RESULTS: The mean range of the knee joint motion decreased from 124.5degrees to 116.2degrees in group 1, and from 118.2degrees to 110.1degrees in group 2. The mean HSS knee score declined from 84.4 points to 75.8 points in group 1, and from 82.3 points to 79.0 points in group 2. The mean tibio-femoral angle changed from 6.3degrees eversion to 5.8degrees in group 1, and from 6.1degrees to 7.2degrees in group 2. The mean time to achieving bone union was 2.7 months in group 1 and 3 months in group 2. CONCLUSION: Both retrograde intramedullary nailing and locking compression plate fixation, as surgical procedures for the treatment of periprosthetic supracondylar femur fractures that occur subsequent to total knee replacement, allow solid fixation and early resumption of joint movement without any statistically significant differences between the two procedures. So, both procedures appear to be good methods of treatment.

Treatmcnt of postoperative non-union of distal humeral fracture with retrograde intramedullary nailing combined with bone graft / 中国矫形外科杂志

[Objective]To explore a new therapy for postoperative non-union distal humeral frature.[Method]From January 2000 to January 2005,27 cases of non-union after internal fixation operations of distal humeral fractures were treated with retrograde intramedullary nailing combined with bone graft.[Result]All cases were followed up form 6 months to 32 months,with an average of 16 months.All the non-union were healed and joint function resumed to normal.No infection,no nail and locking bolts broken and no humeral distal fracture were found.[Conclusion]Retrograde intramedullary nailing combined with bone graft is an effective therapy for postoperative non-union of distal humeral fracture.

Retrograde Intamedullary Nailing for Femoral Fracture

PURPOSE: To evaluate the effectiveness. analyze the result after retrograde intramedullary (IM) nailing in femoral shaft fracture MATERIALS AND METHODS: Thirty-four femoral shaft fracture (32 patients) were operated with retrograde IM nail and followed the result for more than 18 month from march 2001 to march 2003. There were 6 of femoral mid shaft fractures and 28 of distal femur fractures. According to AO classification, there were 1 of A1, 1 of A2, 2 of A3, 2 of C1 in femoral mid shaft fracture and 11 of A1, 7 of A2, 7 of A3, 1 of B1, 2 of C1 in distal femur fracture. They included 5 open fracrures. By Gustilo classification there were 3 of type I, 2 of type II. Through radiologic study we evaluated the time of union, nonunion, malunion. And in clinical evaluation we checked knee function in 18 month after operation. RESULTS: It took 16 weeks (range 12~20 weeks) for average bone uion period. 30 cases out of 34 cases had the bone union but 4 cases showed nonunion. There were not any complication except 3 cases of screw migration. Full rage of motion was gained in 29 cases. However knee stiffness occurred in 5 cases. The knee function through knee score was assessed by showing 28 of excellent, 1 of good, 5 of poor. CONCLUSION: Even though the retrograde intramedullary nailing may have some defect to be able to damage to knee joint in operating, It can be useful surgical technique for femoral shaft fracture in such as ipsilateral fracture or multiple fracture, poor general condition, and so on.

Treatment of the Distal Femur Fracture with Retrograde Intramedullary Nailing

PURPOSE: To evaluate the results and complications of the retrograde intramedullary nailing for the treatment of distal femur fracture. MATERIALS AND METHODS: Thirty three patients who received retrograde IM nailing for fractures of the distal femur between October 1998 to December 2003. Average age was 53.8+/-17 (17~86) years. The average follow up period was 19.4 (12~36) months. Clinical information included age, sex distribution, associated fracture and fracture was classified by AO classification. Functional result was evaluated by Schatzker's criteria. RESULTS: The most common cause of injury was traffic accident (60%). The type of fracture were 6 A1 cases, 5 A2 cases, 11 A3 cases, 5 C2 cases, 6 C3 cases by AO classification. Among the 33 cases, 15 cases were excellent, 9 good, 6 fair and 1 failure according to Schatzker's criteria. Average union time was 9.7+/-3.5 months. CONCLUSION: Treatment of distal femur fracture with retrograde intramedullary nailing was useful due to its minimal invasiveness and early range of motion, more rigid fixation.

Treatment of Supracondylar-Intercondylar Femoral Fractures with a Retrograde Intramedullary Nailing

PURPOSE: We analyzed the cases of supracondylar-intercondylar femoral fracture treated with retrograde intramedullary nail and report the clinical results and its usefulness. MATERIALS AND METHODS: We reviewed 17 cases of supracondylar-intercondylar femoral fracture that had been treated with retrograde intramedullary nail and each of patients had been followed up for a minimum one year. Post-operative functional assessment was performed using a scale developed by Sanders et al. The evaluation scale assesses range of motion, pain, walking ability, return to work, and alignment and shortening as measured on radiograph. RESULTS: According to functional assessment of Sanders et al, there were 6 excellent, 9 good, 1 fair, and 1 poor results, that is, 94% showed above excellent results. Bony union was obtained in average 5 months after operation. The post-operative complications were varus deformity in 1 case, wound infection in 1 case, stiffness of knee joint in 1 case, and metal failure in 1 case. CONCLUSION: The treatment of supracondylar-intercondylar femoral fracture with retrograde intramedullary nail is one of the good surgical options for clinically preferable results with the advantages in early joint motion and early ambulation.