Oncologic uses of the retrograde femoral nail

Destructive lesions about the distal femur represent difficult treatment situations. Patients who present with impending or pathologic fractures require a method of fixation that provides adequate stabilization to allow for early, pain-free ambulation. Other considerations include restoration of functional range of motion, low perioperative morbidity and mortality risk, and minimal soft tissue dissection. Eleven patients with 12 pathologic or impending fractures of the distal femur who were treated with retrograde intramedullary nailing with and without polymethylmethacrylate augmentation were retrospectively reviewed. Followup averaged 17 months. Postoperative range of motion averaged 94 degrees flexion, 90% of patients reported no or modest pain, 81% were functioning with no restrictions or recreational restrictions only, and all patients were enthusiastic or satisfied with their surgical outcome. There were no perioperative mortalities, but one patient had 2 cm shortening secondary to broken distal locking screws and asymptomatic nail protrusion into the knee. Using the system for functional evaluation of reconstructive treatment of tumors of the musculoskeletal system, the average score for each patient was 25 (range, 18-30) or 83% (60%-100%) of the maximum score. The retrograde nail was an easy and successful method of fixation in this clinical setting.