Enclavado endomedular retrógrado en fracturas diafisarias de fémur: indicaciones, técnica y resultados / Retrograde nailing in femoral shaft fractures: indications, technique and outcomes

Introducción: El enclavado endomedular fresado anterógrado es el método de elección para el tratamiento de las fracturas diafisarias de fémur. Sin embargo, la técnica retrógrada surgió como alternativa para situaciones en las que la técnica anterógrada tiene ciertas desventajas. Materiales y Métodos: Entre marzo de 2001 y enero de 2011, se realizaron 110 enclavados retrógrados de fémur, 34 de ellos en pacientes con fracturas diafisarias de fémur. Los mecanismos de lesión fueron: colisión vehicular (15 casos), traumatismo de baja energía (18 casos) y proyectil de arma de fuego (1 caso). Once pacientes (31 %) tenían lesiones asociadas. Resultados: Treinta y tres pacientes consiguieron la consolidación ósea (97 %). El tiempo medio de consolidación fue de 84 días para los clavos fresados y de 112 días para los no fresados. Hubo un caso de retraso de la consolidación. El rango de movilidad de la rodilla promedio fue de 130º de flexión (mínimo 100º y máximo 150º). Seis pacientes (17,6 %) refirieron dolor de rodilla. Conclusiones: El clavo retrógrado para el tratamiento de fracturas diafisarias de fémur consigue resultados de consolidación similares a los del clavo anterógrado de fémur. Sus posibles ventajas son la técnica simple, un menor tiempo quirúrgico y la posibilidad de operar sin el uso de una mesa de tracción.

Background: The antegrade intramedullary reamed nailing is the method of choice for treating diaphyseal femoral fractures. nevertheless, the retrograde technique has emerged as an alternative for situations in which the antegrade one presents certain disadvantages. Methods: Between March 2001 and January 2011, 110 femoral retrograde nailings were performed. thirty-four were performed in patients with diaphyseal femoral fractures. Mechanisms of injury were vehicular collision (15 cases), low energy trauma (18 cases) and ballistic trauma (1 case). Eleven patients (31 %) presented associated injuries. Results: thirty-three patients achieved consolidation (97 %). Healing after procedure occurred at 84 days for the reamed group and 112 for the undreamed one. We had one case of consolidation delay that was resolved inserting a larger diameter reamed nail together with autologous graft. The average range of motion was 130º of flexion (minimum 100º, maximum 150º). Six patients (17.6 %) reported knee pain. Conclusions: the retrograde nailing for diaphyseal femoral fractures yields consolidation results similar to those of the antegrade nailing. the possible advantages are: simple technique, the avoidance of traction table use during surgery and shorter surgical time.

The Use of a Ti-Ni Shape Memory Alloy Ring Bone Fixator During the Retrograde Nailing of Supracondylar Femoral Fractures

PURPOSE: To identify the effects of using a Ti-Ni shape memory alloy ring shaped bone fixator (SMA-rBF) during the retrograde nailing of supracondylar femoral fractures. MATERIALS AND METHODS: The authors reviewed 25 patients with a supracondylar femoral fracture treated by retrograde intramedullary nailing with or without SMA-rBF (group S, 12/25; group N, 13/25). Radiological measurements of angular deformity were performed and functional assessments were made using the Sanders grading system. RESULTS: All fractures healed after an average of 12.2 weeks (range, 9-15 weeks) in group N and after 11.6 weeks (range, 10-13 weeks) in group S (p=0.351). The mean angle of coronal angular deformity was valgus 0.8degrees (range, varus 2.3degrees-valgus 4.5degrees) in group N and valgus 0.7degrees (range, varus 1.0degrees-valgus 2.4degrees) in group S (p=0.892). The mean angle of sagittal angular deformity was 1.0degrees in extension (range, flexion 3.2degrees-extension 3.1degrees) in group N and 0degrees (range, flexion 2.1degrees-extension 1.2degrees) in group S (p=0.022). However, functional grading evaluations revealed no differences between the two groups. CONCLUSIONS: When reduction of a distal femoral fracture with retrograde nailing was difficult additional mini-open reduction and fixation with a ring shaped SMA did not delay or prevent bony union and resulted in good postoperative alignment.

Retrograde Intramedullary Nailing for the Treatment of Ipsilateral Femoral Shaft and Neck Fracture / 대한정형외과학회잡지

PURPOSE: To evaluate the results of the operative method for ipsilateral femoral shaft and neck fractures using retrograde nailing technique. MATERIALS AND METHODS: Seventeen fractures (sixteen patients), followed-up more than 1 year, were included in this study. There were 14 men and 2 women, and the mean age was 44 years-old. According to the Winquist-Hansen classification, type II was most common with 11 cases. In femoral neck fractures, type B was most common with 13 cases according to AO-OTA classification and 6 of them were type II in Garden stage. After retrograde nailing of femoral shaft fractures, neck fractures were fixed by cannulated screw or dynamic hip screw. RESULTS: The average time for union of shaft fractures was 27.3 (14-60) weeks. Nonunion occurred in five patients, who required bone grafts or changes of fixation. The average time for union of neck fractures was 11 (8-12) weeks. All united, except for one case of nonunion with avascuar necrosis, which was a Garden stage IV fracture. Functional results using Friedman-Wyman criteria were good in 16 cases, and fair in one. The only fair result was nonunion of the femoral neck, which had the joint arthroplasty. CONCLUSION: Although the union rate of femoral shaft must be improved, retrograde nailing can provide an easy fixation and a favorable result for ipsilateral femoral neck fractures.

Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture

PURPOSE: To compare retrospectively the antegrade and retrograde nailing in the management of ipsilateral femoral neck and shaft fractures. MATERIALS AND METHODS: Thirty-two patients (thirty-three injuries) were included in this study. Mean age of patients was 38 years-old in the antegrade nailing group (16 injuries) and 44 years-old in the retrograde nailing group (17 injuries). We compared the union of fractures and complications between two groups, and investigated the influencing factors. RESULTS: Femoral shaft fracture was united in 10 cases (63%) of antegrade group and 12 cases (71%) of retrograde group, at 28.2 and 27.3 weeks respectively. Nonunion was more prevalent in Winquist-Hansen III and IV (5 in antegrade nailing, 3 in retrograde nailing) than I and II. Femoral neck fracture was united with 1 case of nonunion in each group. Nonunion developed from Garden stage IV, but fractures of Garden stage I and II united regardless of methods. CONCLUSION: In ipsilateral femoral neck and shaft fractures, the kinds of methods did not affect the results of shaft fractures. Minimally displaced neck fractures also were not influenced by kinds of methods, but retrograde nailing may have a benefit in fixing the displaced neck fractures

Treatment of femoral shaft fractures with retrograde intramedullary nailing through knee joint / 中华创伤骨科杂志

Objective To explore the indication and the procedure of operative treatment for femoral shaft fractures with retrograde intramedullary nailing through knee joint. Methods In the 12 cases of femoral shaft fracture, a 5cm incision inside the patella ligament was made under radioscopy, with the knee flexing to 30?to 40?, and the interlocking nail was inserted reversely through femoral intercondylar. Open reduction was done in 5 cases to correct dislocation, and closed reduction in 7 cases. Results All the cases were followed up for an average of one year. Their fractures healed, and their function of the knee joint recovered well. Conclusions The interlocking nail inserted reversely through the knee joint is a feasible therapy to treat femoral shaft fractures. It is simple, and provides rigid fixation and early functional exercises to recover the knee joint. It does not affect the knee joint function in a short term, but its long term effects still need further follow up.

Supracondylar and intercondylar femur comminuted fractures treated percutaneously with the GSH re-strograde femural nail / 中华创伤骨科杂志

Objective To find an ideal operative method of i nteral fixation for supracondylar a nd in-tercondylar femur comminuted fractures.Methods 30cases with supracondylar and inte rcondylar femur frac-tures were treated percutaneously with retrograde femoral intramedullary nail(GSH)in condition of close reduction technique with assistance of endosc ope and fluroscope.Results The mean 115ml blood loss was seen in 30cases without grafting intraoperatively.Thigh edema recovery and over90?knee flexion motion were seen one week after the operation.All fractu res were united in 6months.Postoperative following-up for 18months revealed the mean 125?knee motion,normal gait in all cases,no varus or valgus defo rmities and no osteoarthotitis.Conclusion The percutaneous tech.of retrograd e nailing with assistance of endosco pe and fluroscope is an ideal surgery method to treat supracondylar and intercondylar femur factures.