Treatment of distal femur fractures with retrograde intramedullary nailing utilizing a tibial nail

Year 2023, Volume: 6 Issue: 1, 73 - 76, 12.01.2023

Yılmaz Ergişi Mesut Tıkman Selçuk Korkmazer Ozan Altun Halil Kekeç Erdi Özdemir Uygar Daşar

https://doi.org/10.32322/jhsm.1197527

Abstract

Aim: Retrograde intramedullary nailing for the treatment of femur fractures is a sound option due to its advantages including ease of implant placement and better control of the distal segment, especially in distal femur fractures. Unfortunately, retrograde femoral nails are not available in most developing countries or rural areas. The primary aim of the study is to investigate the outcomes of an alternative treatment of distal femur fracture with retrograde intramedullary nailing using a tibial nail.
Material and Method: Patients who had distal femur fractures and underwent retrograde intramedullary nailing with a tibial nail between January 2020–March 2022 are retrospectively evaluated. Patients who were treated other than a tibial nail, aged below 18, had follow-up less than 6 months, multiple fractures, and open fractures were excluded. Patients’ demographics, time to union, and complications were recorded. Functional outcomes included visual analogue pain score (VAS), Lysholm score, Tegner activity scale, Knee Society Score (KSS), and Short Form-36 (SF36) on the latest follow-up.
Results: A total of 15 patients (11 male, 4 female) met the inclusion criteria and included in the study. The mean age of the patients was 42.9±17.3 (range, 18 to 72) months. The mean follow-up period was 10.1±5.2 months (range, 6 to 18). There was no reduction loss and implant failure during follow-ups. One patient had nonunion. No intraoperative fracture occurred. Persistent knee pain was seen in a patient due to an intraarticular screw and removed arthroscopically. In the latest follow-up, the mean VAS was 0.73±0.70 (range, 0 to2), the mean Tegner score was 5.0±1.5 (range, 3 to 7), the mean Lysholm score was 90.9±9.9(range, 64 to 100), the mean KSS was 86.6±8.6 (range, 70 to 97), and the mean SF-36 score was 96.5±4.7 (range, 87 to 100).
Conclusion: The results of this study suggest that a tibial nail with retrograde intramedullary nailing has good functional outcomes in the treatment of distal femur fractures. The tibial nail should be considered as an alternative treatment option where retrograde femoral nails are not available.

Keywords

Femur, tibia, nail, plate, fixation, retrograde nail

References

• Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures. Int Orthop 2018; 42: 191-6.
• Hake ME, Davis ME, Perdue AM, Goulet JA. Modern implant options for the treatment of distal femur fractures. J Am Acad Orthop Surg 2019; 27: e867-e75.
• Barzen S, Buschbeck S, Hoffmann R. Distal femoral fractures. Unfallchirurgie (Heidelb). 2022; 125: 507-17.
• Seyhan M, Cakmak S, Donmez F, Gereli A. Blocking screws for the treatment of distal femur fractures. Orthopedics 2013; 36: e936-41.
• Henderson CE, Lujan T, Bottlang M, Fitzpatrick DC, Madey SM, Marsh JL. Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation. Iowa Orthop J 2010; 30: 61-8.
• Hoskins W, Sheehy R, Edwards ER, et al. Nails or plates for fracture of the distal femur? data from the Victoria Orthopaedic Trauma Outcomes Registry. Bone Joint J 2016; 98-B: 846-50.
• Frankle M, Cordey J, Sanders RW, Koval K, Perren SM. A biomechanical comparison of the antegrade inserted universal femoral nail with the retrograde inserted universal tibial nail for use in femoral shaft fractures. Injury 1999; 30: A40-3.
• Rodgers WB, Kennedy JG, Coran DL, Goodman LJ, Lhowe DW. Retrograde intramedullary nailing of the femur using a tibial nail--the adjunctive use of an existing implant: a case report. Bull Hosp Jt Dis 1996; 55: 78-80.
• Gangavalli AK, Nwachuku CO. Management of distal femur fractures in adults: an overview of options. Orthop Clin North Am 2016; 47: 85-96.
• Quinzi DA, Ramirez G, Kaplan NB, Myers TG, Thirukumaran CP, Ricciardi BF. Early complications and reoperation rates are similar amongst open reduction internal fixation, intramedullary nail, and distal femoral replacement for periprosthetic distal femur fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141: 997-1006.
• Neradi D, Sodavarapu P, Jindal K, Kumar D, Kumar V, Goni V. Locked plating versus retrograde intramedullary nailing for distal femur fractures: a systematic review and meta-analysis. Arch Bone Jt Surg 2022; 10: 141-52.
• Magill H, Ponugoti N, Selim A, Platt J. Locked compression plating versus retrograde intramedullary nailing in the treatment of periprosthetic supracondylar knee fractures: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16: 78.