INITIAL EXPERIENCE WITH THE TREATMENT OF SUPRACONDYLAR FEMORAL FRACTURES USING THE SUPRACONDYLAR INTRAMEDULLARY NAIL - A PRELIMINARY-REPORT

Initial experience at a Level I Trauma Center with the use of a retrog rade supracondylar intramedullary (IM) nail for the treatment of supra condylar and supracondylar-intercondylar intraarticular fractures of t he distal femur is presented. Thirty-eight patients with 41 complex di stal femur fractures were treated with this newly developed retrograde IM rod. These included 22 open fractures and 19 closed fractures. Fou r nonunions occurred, but all progressed to union after revision inter nal fixation and bone grafting. Two of five delayed unions required re vision fixation. Two required screw renewal and dynamization. Thirty-f ive of 41 knees achieved at least 90-degrees of knee motion. There wer e no infections and no problems with wound healing. Four patients deve loped fatigue fractures of the rod. These mechanical failures occurred when 11- and 12-mm nails were used in conjunction with 6.4-mm interlo cking screws. The rod system was therefore modified to include 12- and 13-mm diameter nails and smaller 5.0-mm interlocking screws. There ha ve been no subsequent nail failures. We are cautiously optimistic that supracondylar IM rod fixation will contribute to the management of th ese difficult fractures. However, further clinical trials and addition al biomechanical testing should be undertaken prior to widespread use of this device.