RETROGRADE NAILING OF FEMORAL-SHAFT FRACTURES

Objective: The purpose of the study was to define the outcome followin g retrograde nailing of the femoral shaft. Design: Retrospective clini cal study. Materials and Methods: Seventeen retrograde intramedullary nailings of the femur were performed in 16 patients for management of complex orthopedic trauma, Thirteen patients were followed for an aver age of 22.8 months (range from 9 to 72 months), The indications for re trograde nailing were an ipsilateral femoral neck and shaft fracture i n eight cases, knee disarticulation or long above knee amputation asso ciated with a femoral shaft fracture in five cases, traumatic arthroto my of the knee ipsilateral to a shaft fracture in two cases, one case of a shaft fracture ipsilateral to an acetabular fracture that require d an extensile exposure, and one case of a femoral nonunion with a kne e contracture, In fourteen of the seventeen cases the femur fracture w as open including two grade III C injuries. Measurements and Main Resu lts: Two patients died in the early postoperative period due to the se verity of the initial trauma and one patient was lost to follow-up, Th e results were generally poor and postoperative complications were com mon, There were five nonunions in the group, one which required revisi on to an above knee amputation for an infected nonunion following a gr ade III open femur fracture, The average range of motion of the knee w as 3 degrees to 110 degrees, and two patients had an extensor lag of 5 degrees or more, Six patients underwent removal of hardware through a second arthrotomy with no significant loss of knee function related t o the second procedure. Conclusions: The authors concluded that the hi gh complication rate and poor results were related to the severity of the initial injury, An intercondylar starting can be used in properly selected cases with minimal effect on knee function,