Retrograde nailing of femur fractures in patients with myelopathy and who are nonambulatory

The authors studied 10 consecutive patients with closed femoral shaft or su pracondylar fractures who mere nonambulatory and who mere treated by reamed retrograde intramedullary nailing,ia an intercondylar notch approach. The study consisted of five women and five men with an average age of 60.7 year s (range, 40-89 gears). Sis patients had spinal cord lesions, one had a bra in injury, one had cerebral palsy, one had multiple sclerosis, and one had progressive myelopathy. Three fractures were supracondylar, and seven fract ures involved the mid-distal diaphysis. The average time of surgery was 110 minutes (range, 70-225 minutes) with an average estimated blood loss of 28 8 mt (range, 150-400 mt). There were two postoperative deaths (at 15 days a nd 2 months, respectively) after the procedure that were attributable to pn eumonia. The remaining eight patients were observed for an average of 13 mo nths (range, 6-30 months) after surgery. All fractures healed as evaluated radiographically. Retrograde intramedullary nailing is a simple, safe, and effective alternative to nonoperative treatment for femoral shaft or suprac ondylar fractures in patients who are nonambulatory. Stabilization by this method allows fracture healing and rapid return of patients to their previo us level of function. There mere no nonunions, malunions, significant short ening, implant failure, or mound infections.