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Supracondylar nail failure: two case reports.

N S Thompson¹, E A Cooke, B F Craig

¹Fracture Unit, Belfast City Hospital, Northern Ireland, UK.

International Journal of Clinical Practice

|November 24, 1999

Summary

Retrograde intramedullary nails for severe femur fractures can fail due to early patient activity. Revision with dynamic condylar screws and bone grafting achieved solid union, highlighting the need for careful rehabilitation.

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Area of Science:

Orthopedic surgery
Trauma management
Biomedical engineering

Background:

Supracondylar femoral fractures are severe injuries often treated with intramedullary nails.
Retrograde intramedullary nailing is a common surgical approach for these fractures.
Implant failure can occur, necessitating revision surgery.

Observation:

Two young patients experienced failure of retrograde intramedullary nails used for high-energy comminuted supracondylar femoral fractures.
Implant failure was attributed to excessive patient activity before full knee flexion and fracture consolidation.
The failed nails were removed, and revision surgery involved dynamic condylar screws and bone grafting.

Findings:

The revision procedure using dynamic condylar screws and bone grafting resulted in solid bony union.
This indicates the effectiveness of the revision strategy in managing implant failure.
Successful union was achieved despite the initial complication.

Implications:

Patients treated with retrograde intramedullary nails for supracondylar femur fractures require careful post-operative management.
Restrictions on weight-bearing and strenuous physiotherapy are crucial until fracture consolidation and functional knee motion are achieved.
Management of failed implants should involve nail removal, bone grafting, and consideration of dynamic condylar screw fixation.

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