Antegrade versus retrograde intramedullary nailing of proximal third femur fractures

The purpose of this study is to retrospectively review the results of proximal third femur fractures treated with retrograde nailing (RGN) and compare those results to a cohort from the same period treated with antegrade nailing (AGN). Adult patients with femur fractures within 10 cm of the lesser trochanter who were treated with intramedullary nails were reviewed. Two groups, patients treated with AGN (n = 35) and RGN (n = 34), were compiled. Demographic information, comorbidities, associated injuries, radiographic outcomes, complications, and secondary procedures were compared. There were two malunions in the AGN group and three in the RGN group. The AGN group had two nonunions while the RGN group had one. Subgroup analysis demonstrated that a higher body mass index (BMI) (p = .011) and a higher AO/OTA fracture classification (p = .019) were the only factors predictive of malunion. Regardless of starting point, there were no differences between groups in the number of secondary procedures, nonunions, malunions, or time until union.