Retrograde nailing for diaphyseal femoral fracture: indications, technique and outcomes
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Published:
Dec 20, 2014
Keywords:
Diaphyseal femoral fracture. Retrograde nailing. Outcomes.
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Abstract
Background: the antegrade intramedullary reamed nailing is the method of choice for treating diaphyseal femoral fractures. Nevertheless, the retrograde technique has emerged as an alternative for situations in which the antegrade one presents certain disadvantages.Methods: between March 2001 and January 2011, 110 femoral retrograde nailings were performed. Thirty-four were performed in patients with diaphyseal femoral fractures. Mechanisms of injury were vehicular collision (15 cases), low energy trauma (18 cases) and ballistic trauma (1 case). Eleven patients (31%) presented associated injuries.Results: thirty-three patients achieved consolidation (97%). Healing after procedure occurred at 84 days for the reamed group and 112 for the undreamed one. We had one case of consolidation delay that was resolved inserting a larger diameter reamed nail together with autologous graft. The average range of motion was 130º of flexion (minimum 100º, maximum 150º). Six patients (17.6%) reported knee pain.Conclusions: the retrograde nailing for diaphyseal femoral fractures yields consolidation results similar to those of the antegrade nailing. The possible advantages are: simple technique, the avoidance of traction table use during surgery and shorter surgical time.
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Pereira, S., Lugones, A., Vindver, G. I., & Bidolegui, F. M. (2014). Retrograde nailing for diaphyseal femoral fracture: indications, technique and outcomes. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 79(4), 210-217. https://doi.org/10.15417/340
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Clinical Research
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References
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twenty cases. J Bone Joint Surg Am 1984;66(4):529-39.
2. Benirschke SK, Melder I, Henley MB, Routt ML, Smith DG, Chapman JR, et al. Closed interlocking nailing of femoral
shaft fractures: Assessment of technical complications and functional outcomes by comparison of a prospective with retrospective
review. J Orthop Trauma 1993;7:118-22.
3. Tornetta P, Tiburzi D. The treatment of femoral shaft fractures using intramedullary interlocked nails with and without
intramedullary reaming: a preliminary report. J Orthop Trauma 1997;11:89-92.
4. Murray P, Bergin P, Labropoulos P, Gunther S. Retrograde femoral nailing and knee function. Orthopedics 2008;31(10).
5. Brumback RJ, Ellison TS, Molligan H, Molligan DJ, Mahaffey S, Schmidhauser C. Pudendal nerve palsy complicating
intramedullary nailing of the femur. J Bone Joint Surg Am 1992;74:1450-5.
6. Kao JT, Burton D, Comstock C, McClellan RT, Carragee E. Pudendal nerve palsy after femoral intramedullary nailing.
J Orthop Trauma 1993;7:58-63.
7. Sanders R, Koval KJ, DiPasquale T, Helfet DL, Frankle M. Retrograde reamed femoral nailing. J Orthop Trauma 1993;7:293-
302.
8. Bain GI, Zacest AC, Paterson DC, Middleton J, Pohl AP. Abduction strength following intramedullary nailing of the femur.
J Orthop Trauma 1997;11:93-7.
9. Swiontkowski MF, Hansen ST, Kellam J. Ipsilateral fractures of the femoral neck and shaft. J Bone Joint Surg Am
1984;66:260-8.
10. Patterson BM, Routt MLC Jr, Benirschke SK, Hansen ST Jr. Retrograde nailing of femoral shaft fractures. J Trauma
1995;38:38-43.
11. Heim U, Näser M. Operative treatment of distal tibial fractures. Technique of osteosynthesis and results in 128 patients. Arch
Orthop Unfallchir 1976;86(3):341-56.
12. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is pain in millimetres? Pain 1997;72:95-7.
13. Pape HC, Remmers D, Regel G, Tscherne H. Pulmonary complications following intramedullary stabilization of long bones.
Effect of surgical procedure, time and injury pattern. Orthopade 1995;24(2):164-72.
14. Moed BR, Watson JT. Retrograde intramedullary nailing, without reaming, of fractures of the femoral shaft in multiply injured
patients. J Bone Joint Surg Am 1995;77:1520-7.
15. Herscovici D Jr, Whiteman KW. Retrograde nailing of the femur using an intercondylar approach. Clin Orthop 1996;332:98-
104.
16. Ricci WM, Bellabarba C, Evanoff B, Herscovici D, DiPasquale T, Sanders R. Retrograde versus anterograde nailing of
femoral shaft fractures. J Orthop Trauma 2001;15(3):161-9.
17. Oh CW, Oh JK, Park BC, Jeon IH, Kyung HS, Kim SY, et al. Retrograde nailing with subsequent screw fixation for ipsilateral
femoral shaft and neck fractures. Arch Orthop Trauma Surg 2006;126:448-53.
18. Bhandari M. Ipsilateral femoral neck and shaft fractures. J Orthop Trauma 2003;17:138-40.
19. Calvo X, Salas S, Pereira S, Vindver G, Bidolegui F. Fractura alrededor de una osteosíntesis previa del fémur proximal.
Una solución simple para un problema complejo. Poster presentado en el Congreso de la AAOT 2013.
20. Lundy BW, Johnson KD. Floating knee injuries: Ipsilateral fractures of the femur and tibia. J Am Acad Orthop Surg
2001;9:238-45.
21. Ostrum RF. Treatment of floating knee injuries through a single percutaneous approach. Clin Orthop 2000;375:43-50.
22. Gregory P, DiCicco J, Karpik K, DiPasquale T, Herscovici D, Sanders R. Ipsilateral fractures of the femur and tibia:
treatment with retrograde femoral nailing and unreamed tibial nailing. J Orthop Trauma 1996;10(5):309-16.
23. Giannoudis PV, Tzioupis C, Pape HC. Fat embolism: the reaming controversy. Injury 2006;37(Suppl 4):S50-8.
24. DeLong WG, Bennett FS. The GSH supracondylar nail. En: The Science and Practice of Intramedullary Nailing, 2nd ed. Media,
PA: Williams & Wilkins; 1997:183-97.
25. Janzing HM, Stockman B, Van Damme G, Rommens P, Broos PL. The retrograde intramedullary nail: prospective experience
in patients older than sixty-five years. J Orthop Trauma 1998;12:330-3.
26. Río M, Patricios S, Saa J. Lesiones producidas en la rodilla durante el enclavado endomedular retrógrado del fémur. Estudio
experimental en rodillas cadavéricas. Rev Argent Ortop Traumatol 2009;74:148-51.
27. Morgan E, Ostrum RF, DiCicco J, McElroy J, Poka A. Effects of retrograde femoral intramedullary nailing on the patellofemoral
articulation. J Orthop Trauma 1999;13:13-6.
28. Reina R, Vilella FE, Ramirez N, Valenzuela R, Nieves G, Foy CA. Knee pain and leg length discrepancy after retrograde
femoral nailing. Am J Orthop 2007;36:325-8.
29. Ostrum RF, DiCicco J, Lakatos R, Poka A. Retrograde intramedullary nailing of femoral diaphyseal fractures. J Orthop
Trauma 1998;12:464-8.
30. Aglietti P, Insall JN, Walker PS, Trent P. A new patella prosthesis: Design and application. Clin Orthop 1975;107:175-87.
31. Gellman RE, Paiement GD, Green HD, Coughlin RR. Treatment of supracondylar femoral fractures with a retrograde
intramedullary nail. Clin Orthop 1996;332:90-7.
32. Stubbs M, Zhang H, Vrahas MS, Baratta RV, Zieske A. The effect of intra-articular stainless steel implants on the health of
the rabbit knee joint: An experimental study. Presented at the 44th Annual Meeting of the Louisiana Orthopaedic Association,
New Orleans, November 20-23, 1997.
33. Ostrum RF, Agarwal A, Lakatos R, Poka A. Prospective comparison of retrograde and antegrade femoral intramedullary
nailing. J Orthop Trauma. 2000;14(7):496-501.
34. El Moumni M, Schraven P, Ten Duis HJ, Wendt K. Persistent knee complaints after retrograde unreamed nailing of femoral
shaft fractures. Acta Orthop Belg 2010;76:219-25.
35. Coupe KJ, Beaver RL. Arterial injury during retrograde femoral nailing: a case report of injury to a branch of the profunda
femoris artery. J Orthop Trauma 2001;15(2):140-3.
36. Rina J, Tornetta P III, Ritter C, Geller J. Neurologic and vascular structures at risk during anterior-posterior locking of
retrograde femoral nails. J Orthop Trauma 1998;12:379-81.
twenty cases. J Bone Joint Surg Am 1984;66(4):529-39.
2. Benirschke SK, Melder I, Henley MB, Routt ML, Smith DG, Chapman JR, et al. Closed interlocking nailing of femoral
shaft fractures: Assessment of technical complications and functional outcomes by comparison of a prospective with retrospective
review. J Orthop Trauma 1993;7:118-22.
3. Tornetta P, Tiburzi D. The treatment of femoral shaft fractures using intramedullary interlocked nails with and without
intramedullary reaming: a preliminary report. J Orthop Trauma 1997;11:89-92.
4. Murray P, Bergin P, Labropoulos P, Gunther S. Retrograde femoral nailing and knee function. Orthopedics 2008;31(10).
5. Brumback RJ, Ellison TS, Molligan H, Molligan DJ, Mahaffey S, Schmidhauser C. Pudendal nerve palsy complicating
intramedullary nailing of the femur. J Bone Joint Surg Am 1992;74:1450-5.
6. Kao JT, Burton D, Comstock C, McClellan RT, Carragee E. Pudendal nerve palsy after femoral intramedullary nailing.
J Orthop Trauma 1993;7:58-63.
7. Sanders R, Koval KJ, DiPasquale T, Helfet DL, Frankle M. Retrograde reamed femoral nailing. J Orthop Trauma 1993;7:293-
302.
8. Bain GI, Zacest AC, Paterson DC, Middleton J, Pohl AP. Abduction strength following intramedullary nailing of the femur.
J Orthop Trauma 1997;11:93-7.
9. Swiontkowski MF, Hansen ST, Kellam J. Ipsilateral fractures of the femoral neck and shaft. J Bone Joint Surg Am
1984;66:260-8.
10. Patterson BM, Routt MLC Jr, Benirschke SK, Hansen ST Jr. Retrograde nailing of femoral shaft fractures. J Trauma
1995;38:38-43.
11. Heim U, Näser M. Operative treatment of distal tibial fractures. Technique of osteosynthesis and results in 128 patients. Arch
Orthop Unfallchir 1976;86(3):341-56.
12. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is pain in millimetres? Pain 1997;72:95-7.
13. Pape HC, Remmers D, Regel G, Tscherne H. Pulmonary complications following intramedullary stabilization of long bones.
Effect of surgical procedure, time and injury pattern. Orthopade 1995;24(2):164-72.
14. Moed BR, Watson JT. Retrograde intramedullary nailing, without reaming, of fractures of the femoral shaft in multiply injured
patients. J Bone Joint Surg Am 1995;77:1520-7.
15. Herscovici D Jr, Whiteman KW. Retrograde nailing of the femur using an intercondylar approach. Clin Orthop 1996;332:98-
104.
16. Ricci WM, Bellabarba C, Evanoff B, Herscovici D, DiPasquale T, Sanders R. Retrograde versus anterograde nailing of
femoral shaft fractures. J Orthop Trauma 2001;15(3):161-9.
17. Oh CW, Oh JK, Park BC, Jeon IH, Kyung HS, Kim SY, et al. Retrograde nailing with subsequent screw fixation for ipsilateral
femoral shaft and neck fractures. Arch Orthop Trauma Surg 2006;126:448-53.
18. Bhandari M. Ipsilateral femoral neck and shaft fractures. J Orthop Trauma 2003;17:138-40.
19. Calvo X, Salas S, Pereira S, Vindver G, Bidolegui F. Fractura alrededor de una osteosíntesis previa del fémur proximal.
Una solución simple para un problema complejo. Poster presentado en el Congreso de la AAOT 2013.
20. Lundy BW, Johnson KD. Floating knee injuries: Ipsilateral fractures of the femur and tibia. J Am Acad Orthop Surg
2001;9:238-45.
21. Ostrum RF. Treatment of floating knee injuries through a single percutaneous approach. Clin Orthop 2000;375:43-50.
22. Gregory P, DiCicco J, Karpik K, DiPasquale T, Herscovici D, Sanders R. Ipsilateral fractures of the femur and tibia:
treatment with retrograde femoral nailing and unreamed tibial nailing. J Orthop Trauma 1996;10(5):309-16.
23. Giannoudis PV, Tzioupis C, Pape HC. Fat embolism: the reaming controversy. Injury 2006;37(Suppl 4):S50-8.
24. DeLong WG, Bennett FS. The GSH supracondylar nail. En: The Science and Practice of Intramedullary Nailing, 2nd ed. Media,
PA: Williams & Wilkins; 1997:183-97.
25. Janzing HM, Stockman B, Van Damme G, Rommens P, Broos PL. The retrograde intramedullary nail: prospective experience
in patients older than sixty-five years. J Orthop Trauma 1998;12:330-3.
26. Río M, Patricios S, Saa J. Lesiones producidas en la rodilla durante el enclavado endomedular retrógrado del fémur. Estudio
experimental en rodillas cadavéricas. Rev Argent Ortop Traumatol 2009;74:148-51.
27. Morgan E, Ostrum RF, DiCicco J, McElroy J, Poka A. Effects of retrograde femoral intramedullary nailing on the patellofemoral
articulation. J Orthop Trauma 1999;13:13-6.
28. Reina R, Vilella FE, Ramirez N, Valenzuela R, Nieves G, Foy CA. Knee pain and leg length discrepancy after retrograde
femoral nailing. Am J Orthop 2007;36:325-8.
29. Ostrum RF, DiCicco J, Lakatos R, Poka A. Retrograde intramedullary nailing of femoral diaphyseal fractures. J Orthop
Trauma 1998;12:464-8.
30. Aglietti P, Insall JN, Walker PS, Trent P. A new patella prosthesis: Design and application. Clin Orthop 1975;107:175-87.
31. Gellman RE, Paiement GD, Green HD, Coughlin RR. Treatment of supracondylar femoral fractures with a retrograde
intramedullary nail. Clin Orthop 1996;332:90-7.
32. Stubbs M, Zhang H, Vrahas MS, Baratta RV, Zieske A. The effect of intra-articular stainless steel implants on the health of
the rabbit knee joint: An experimental study. Presented at the 44th Annual Meeting of the Louisiana Orthopaedic Association,
New Orleans, November 20-23, 1997.
33. Ostrum RF, Agarwal A, Lakatos R, Poka A. Prospective comparison of retrograde and antegrade femoral intramedullary
nailing. J Orthop Trauma. 2000;14(7):496-501.
34. El Moumni M, Schraven P, Ten Duis HJ, Wendt K. Persistent knee complaints after retrograde unreamed nailing of femoral
shaft fractures. Acta Orthop Belg 2010;76:219-25.
35. Coupe KJ, Beaver RL. Arterial injury during retrograde femoral nailing: a case report of injury to a branch of the profunda
femoris artery. J Orthop Trauma 2001;15(2):140-3.
36. Rina J, Tornetta P III, Ritter C, Geller J. Neurologic and vascular structures at risk during anterior-posterior locking of
retrograde femoral nails. J Orthop Trauma 1998;12:379-81.