[Value of retrograde femoral nailing : Pros and cons]

Femoral intramedullary nailing is the gold standard in the surgical treatment of femoral shaft fractures and can generally be performed using an antegrade or retrograde technique. As an intramedullary load-sharing device this type of osteosynthesis has biomechanical advantages. Retrograde intramedullary nailing is becoming increasingly more important in the treatment of periprosthetic, metaphyseal and intra-articular distal femoral fractures.

This article aims to demonstrate the value of retrograde femoral nailing and to discuss the clinically relevant advantages and disadvantages that need to be considered.

Systematic literature search using PubMed, Google Scholar and Cochrane Library using the keywords "femoral fracture, retrograde nailing, periprosthetic fracture, intramedullary nailing and locking plate osteosynthesis".

In distal femur fractures retrograde nailing shows significantly less nonunions and infections than lateral locking plate osteosynthesis. In the treatment of intra-articular comminuted distal femur fractures, the rates of complications and revisions were lower with retrograde nailing than with plate osteosynthesis. Counterintuitively, there was no increased risk of septic arthritis of the knee joint after primary treatment of open fractures with a retrograde femoral nail. There is an increased risk of postoperative knee complaints.

Retrograde intramedullary femoral nailing provides many advantages with a comparatively low risk profile and can be used in a variety of forms for femoral fractures. The risk of postoperative knee complaints should be considered when determining the indications.