Iatrogenic Trochlear Chondral Defects After Anterolateral Placement of Retrograde Femoral Nails

Femoral shaft fractures are common injuries with an incidence of 37.1 per 100,000 person-years in the United States. Retrograde femoral nailing is an increasingly used treatment strategy to manage these injuries, particularly in fractures below stemmed hip prostheses, in supracondylar or distal femur fractures, in fractures in pregnant or obese patients, and when concomitant ipsilateral acetabular/pelvic ring fractures are present. Retrograde fixation has been shown to be a viable option with union rates comparable to antegrade intramedullary nailing. Despite having excellent results in the treatment of femoral fractures, retrograde femoral nails have been associated with iatrogenic patellofemoral chondral damage that may occur because of malpositioning of the intramedullary nail at the entry point. The objective of this case report is to describe 2 patients who suffered iatrogenic trochlear chondral defects after retrograde femoral nailing and subsequently underwent osteoarticular allograft transplantation surgery.