Outcomes of Retrograde Nailing for Treating Fractures of Femoral Shaft

Objective: We assessed retrograde locked intramedullary nail outcomes in distal femur fractures patients. Place and Duration: In the Department of Orthopaedic Bone Care trauma centre Heerabad Hospital Hyderabad Pakistan s for one year duration from March 2019 to March 2020. Methods: 26 patients of distal femur fractures (16 men, 10 women; mean age 45 years; range 23 to 66 years) were managed with a retrograde locked intramedullary nail. The bilateral fractures were noted in 2 patients. Closed fractures were noted in 19 (73.07%) and open fractures in 7 (26.9%). 10 days was the mean operative time (range 2 to 20 days). In 15 fractures: open technique was used, and 11 fractures were managed with close technique. 4 patients with floating knee preoperatively were assessed by MRI and found to have torn cruciate ligaments. Intraoperative knee examination was performed in all patients, and cruciate ligament rupture was observed in 7 patients. The HSS modified knee rating scale was used for functional results assessment at the end of a mean follow-up period of 24 months. Results: 27 weeks was the mean time to union (range 15 to 44 weeks). Two patients showed a late union (42 weeks). In 10 knees; Range of motion was normal (38.46%), 100-110 degrees in 12 knees (46.15%), 80 degrees in 3 knees (11.5%) and below 80 degrees in one knee (3.84%). Based on the modified HSS knee scale, the results were excellent in 12 (46.15%), good in 7 (26.92%), moderate in 5(19.2) and poor in 2 (7.69%). Postoperative radiographic check-up revealed varus angulation (10 degrees) in five patients (19.23%) and posterior angulation (10-20 degrees) in 3 subjects. 1 patient recovered with excessive deformation (30 degrees posterior angulation). None of the patients experienced problems or infections at the wound site. Deep vein thrombosis developed in two patients in the early postoperative period. Conclusion: The distal femur fractures treatment with retrograde interlocked intramedullary nailing gives acceptable outcomes in adults.