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Retrograde intramedullary nailing of comminuted intra-articular distal femur fractures results in high union rate

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Retrograde intramedullary nailing of intra-articular distal femur fractures with metaphyseal and/or epiphyseal comminution is controversial and considered a contraindication to nailing. The purpose of this study was to report union rate, complications, and secondary procedures after open reduction and retrograde intramedullary nailing of comminuted, intra-articular, distal femur fractures.

Materials and methods

A retrospective review performed at an urban level one trauma center identified 16 patients AO/Orthopedic Trauma Association (OTA) 33-C2 and 33-C3 femur fractures treated with open reduction, lag screws, and retrograde intramedullary nail fixation. Radiographic union, complications, secondary operations were reviewed.

Results

At the 3-month follow-up 12 (86%) of the 14 patients with radiographs had healed. At last follow-up, all 16 femur fractures achieved radiographic union after the index procedure. No patient required a revision procedure for delayed union or nonunion. Complications occurred in 6 (38%) patients, including failed distal interlocking screws (n = 2), knee arthrofibrosis (n = 3), superficial wound infection (n = 1), and wound dehiscence (n = 1). Three (19%) patients required secondary procedures, which included knee manipulation under anesthesia (n = 3), distal interlocking screw removal (n = 2), and closure of a wound dehiscence (n = 1).

Conclusions

Comminuted intra-articular distal femur fractures that can be successfully treated with retrograde IMN fixation will reliably go on to union with a complication rate that is favorable to that reported for plate fixation.

Level of Evidence:

Level IV, retrospective case-series.

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Authors and Affiliations

  1. Department of Orthopaedics, Orlando Health, Orlando, FL, USA

    Samantha Nino, Frank R. Avilucea, George J. Haidukewych & Joshua R. Langford

  2. Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, MC 0188, Denver, CO, 80204, USA

    Joshua A. Parry

Authors
  1. Samantha Nino
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  2. Joshua A. Parry
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  3. Frank R. Avilucea
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  4. George J. Haidukewych
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  5. Joshua R. Langford
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Corresponding author

Correspondence to Joshua A. Parry.

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Conflict of interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no specific disclosures related to this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The institutional review board approved this study. Due to the retrospective nature of this work, informed consent was waived.

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Nino, S., Parry, J.A., Avilucea, F.R. et al. Retrograde intramedullary nailing of comminuted intra-articular distal femur fractures results in high union rate. Eur J Orthop Surg Traumatol 32, 1577–1582 (2022). https://doi.org/10.1007/s00590-021-03140-8

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  • DOI: https://doi.org/10.1007/s00590-021-03140-8

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