Publication:

Retrograde intramedullary nailing for fractures of distal femur: a prospective study

Background The objective of the present study was to evaluate the clinical and functional outcome of retrograde intramedullary interlocking nailing for fractures of distal femur.

Methods This two-year prospective observational study includes all patients with fractures of distal femur who underwent retrograde intramedullary interlocking nailing.  The patient was placed supine on fracture table with the affected limb flexed to 60o.  Through a transpatellar approach, the nail was introduced in a retrograde method after serial reaming. Postoperatively knee range of motion was started immediately and weight-bearing was progressed after signs of fracture union were noted on x-rays.  The outcome was evaluated for time taken for fracture union, complications and secondary procedures, knee range of motion and function at 1 year follow up using modified knee-rating scale of the hospital for special surgery.

Results There were 21 patients who underwent retrograde intramedullary nailing for fractures of distal femur during the study period. According to AO/ASIF system, fractures were classified as A1 (n=15), A2 (n=3), and A3 (n=3). In 17 patients, fracture united without complications or secondary procedures. Fractures united at a mean time of 19.4 weeks. There were no varus or valgus malalignments but one patient had significant limb shortening. At the end of 1 year, excellent to good functional outcome was noted in 81% of patients.

Conclusions Retrograde intramedullary nail fixation is a reliable method for treatment of fractures of distal femur. It promotes high rates of fracture union with minimal complications. This method does not interfere significantly with the knee function postoperatively.