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Retrograde reamed femoral nailing
R Sanders1, K J Koval, T DiPasquale
1Orthopedic Trauma Service, Tampa General Hospital, Florida.
Journal of Orthopaedic Trauma
|January 1, 1993
Summary
Retrograde femoral nailing offers a viable alternative to antegrade nailing for complex femoral shaft fractures, particularly in cases with associated injuries or pregnancy. This technique demonstrated high healing rates and minimal complications in a small patient cohort.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Surgical Techniques
Background:
- Antegrade femoral nailing is the standard for femoral shaft fractures.
- Certain complex fractures (acetabular, pelvic, femoral neck), polytrauma, and pregnancy pose challenges for antegrade nailing.
Purpose of the Study:
- To evaluate the efficacy and safety of retrograde femoral nailing in specific challenging fracture scenarios.
- To compare retrograde nailing outcomes against established antegrade nailing standards.
Main Methods:
- Retrospective review of 29 retrograde femoral nailings in 24 patients (1988-1990).
- Fractures included open injuries, isthmal/infraisthmal locations, and varying comminution (Winquist and Hansen grades).
- Utilized AO Universal Femoral and Tibial Nails, with insertion via a medial condylar portal.
Main Results:
- Successful nailing in 28/29 cases.
- 92% (23/25) fracture healing within 12 weeks.
- No infections, loss of reduction, or nail failures observed.
- Average knee flexion of 122 degrees with minimal extensor lag.
- Intraoperative complications included insertion site cracks and infraisthmal malreductions.
Conclusions:
- Retrograde reamed femoral nailing is a suitable alternative to antegrade nailing.
- Consider retrograde nailing when proximal access is compromised or undesirable.
- This technique shows promise for complex femoral shaft fractures with specific contraindications to antegrade fixation.