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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Retrograde reamed femoral nailing
Roy Sanders1, Kenneth J Koval, Thomas DiPasquale
1Orthopedic Trauma Service, Tampa General Hospital, Tampa Florida; *Fracture Service, The Hospital for Joint Diseases, Orthopaedic Institute, New York, New York; †Laboratory for Experimental Research, Davos, Switzerland; and ‡Hospital for Special Surgery, New York, New York, U.S.A.
Retrograde femoral nailing offers a viable alternative to antegrade nailing for specific femoral shaft fractures. This technique is particularly useful in cases with associated injuries or when proximal access is challenging.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Biomedical Engineering
Background:
- Antegrade femoral nailing is the standard for femoral shaft fractures.
- Certain complex cases, including pelvic/acetabular fractures, polytrauma, and pregnancy, present challenges for antegrade nailing.
- Alternative techniques are needed for these specific clinical scenarios.
Purpose of the Study:
- To evaluate the efficacy and safety of retrograde femoral nailing.
- To assess retrograde nailing as an alternative to antegrade nailing in challenging femoral shaft fracture cases.
Main Methods:
- Retrospective review of 29 retrograde femoral nailings in 24 patients (1988-1990).
- Fractures included ipsilateral pelvic/femoral injuries, polytrauma, and open fractures.
- Nail insertion via an extraarticular medial condylar portal, using AO Universal Femoral or Tibial Nails.
Main Results:
- Successful nailing in 28/29 cases.
- 92% of fractures healed within 12 weeks, with no infections, loss of reduction, or nail failures.
- Average knee flexion was 122°, with minimal extensor lag; minor intraoperative complications noted.
Conclusions:
- Retrograde reamed femoral nailing is a suitable alternative to antegrade nailing.
- This technique should be considered when proximal access for antegrade nailing is not feasible or desirable.
