RETROGRADE REAMED FEMORAL NAILING

Closed, reamed, antegrade nailing remains the standard of care for fem oral shaft fractures. This technique however, may be less attractive i n the management of femoral shaft fractures associated with (a) ipsila teral acetabular, pelvis, or femoral neck fractures; (b) polytrauma re quiring multiple simultaneous surgical procedures; and (c) pregnancy. We now report on our experience with the retrograde femoral nailing as a treatment option in these situations. Between 4/88 and 10/90, 29 re trograde femoral nailing in 24 patients were attempted. Average age wa s 29.3 (16-74) years. Five fractures were open. Fracture location was isthmal in 14 and infraisthmal in 15. The comminution was classified a ccording to Winquist and Hansen: I(10), II(7), III(7), and IV(5). Nail ing was possible in 28/29 cases. Insertion was made through an extraar ticular medial condylar portal. Nail diameter ranged from 10 to 13 mm. An AO Universal Femoral Nail was used in the first 11 cases: all subs equent fractures were stabilized using an AO Universal Tibial Nail bec ause its design appeared better suited to this technique. Follow-up wa s possible for 25 fractures in 21 patients and averaged 16.0 (range, 1 1-27); months 23/25 (92%) fractures healed within 12 weeks. No case wa s associated with an infection, loss of reduction, or nail failure. Kn ee flexion averaged 122-degrees; only two knees had an extensor lag of >5-degrees. Intraoperative complications included three cases of crac k propagation at the insertion site, and four infraisthmal malreductio ns (two valgus, two flexion). Based on these results, we feel that ret rograde reamed femoral nailing is a suitable alternative to antegrade nailing and should be considered in situations where proximal access i s neither possible nor desirable.