Abstract
Introduction: Fracture of the distal end of femur may result following direct impact as seen in cases of assault, road traffic accidents and after fall from height. Due to strong muscles surrounding femur these fractures are usually displaced. Retrograde intramedullary nailing has been considered a good surgical option with minimal complications and better outcome in patients with distal femur fracture. The purpose of the present study was to find out the outcome of distal femoral fractures treated with retrograde nailing.
Aims and Objectives: To study the outcome of distal femoral fracture cases treated by retrograde intramedullary nailing.
Materials and Methods: This study was conducted in the department of orthopedics of a tertiary care medical college situated in an urban area. All patients admitted with distal femoral fractures and treated with retrograde nailing were included in this study depending upon a predefined inclusion and exclusion criteria. Detailed history was taken in all patients also clinical examination and relevant imaging was done. All patients were treated by retrograde nailing. Patients were followed up at least for 1 year. The outcome was assessed using Tegner Lysholm Scoring Scale.
Results: Out of 25 cases with distal femoral fractures there were 18 (72%) males and 7 (28%) females with a M:F ratio of 1:0.38. The most common cause of fracture was found to be road traffic accidents (68%). Individuals with high BMI were found to be prone for fractures. The difference of fracture risk between individuals with normal and high BMI was found to be statistically significant (P<0.005). At the end of 1 year follow up 84% patients had excellent outcome while Good and fair outcome was seen in 8%, 4% respectively. Only 1 patient had poor outcome and had a Tegner Lysholmscore of less than 65.
Conclusion: Retrograde intramedullary nailing was found to be very effective method of treatment with excellent outcome in patients with distal femoral fractures. The studied cases were found to have satisfactory functional outcome during 1 year follow up period.
Keywords: Distal Femoral Fractures, Retrograde nailing, Functional Outcome,Tegner Lysholm Scoring Scale.
References
- Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q. Distal femoral fractures: current concepts. J Am Acad Orthop Surg. 2010 Oct;18(10):597-607.
- Brizola E, Zambrano MB, Pinheiro B de S, Vanz AP, Félix TM. Clinical features and pattern of fractures at the time of diagnosis of osteogenesis imperfecta in children. Revista Paulista de Pediatria. 2017;35(2):171-177.
- Zacherl M, Gruber G, Glehr M, et al. Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: Resection vs. stabilisation. International Orthopaedics. 2011;35(10):1537-1543.
- Wood SP, Vrahas M, Wedel SK. Femur fracture immobilization with traction splints in multisystem trauma patients. Prehosp Emerg Care. 2003 Apr-Jun;7(2):241-3.
- Raschke MJ, Alt N. [Complications after osteosynthesis of the proximal femur]. Orthopade. 2014 Jan;43(1):35-46.
- Kanabar P, Kumar V, Owen PJ, Rushton N. Less invasive stabilisation system plating for distal femoral fractures. J Orthop Surg (Hong Kong). 2007 Dec;15(3):299-302.
- Pintore E, Maffulli N, Petricciuolo F. Interlocking nailing for fractures of the femur and tibia. Injury. 1992;23(6):381-6.
- Yu CK, Singh VA, Mariapan S, Chong ST. Antegrade Versus Retrograde Locked Intramedullary Nailing for Femoral Fractures: Which Is Better? Eur J Trauma Emerg Surg. 2007 Apr;33(2):135-40.
- Fantry AJ, Elia G, Vopat BG, Daniels AH. Distal Femoral Complications Following Antegrade Intramedullary Nail Placement. Orthopedic Reviews. 2015;7(1):5820.
- Briggs KK, Kocher MS, Rodkey WG, Steadman JR. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patientswith meniscal injury of the knee. J Bone Joint Surg Am. 2006 Apr;88(4):698-705.
- Kumar M, Akshat V, Kanwariya A, Gandhi M. A Prospective Study to Evaluate the Management of Sub-trochanteric Femur Fractures with Long Proximal Femoral Nail. Malaysian Orthopaedic Journal. 2017;11(3):36-41.
- Werner-Tutschku W, Lajtai G, Schmiedhuber G, Lang T, Pirkl C, Orthner E. [Intra- and perioperative complications in the stabilization of per- and subtrochanteric femoral fractures by means of PFN] Unfallchirurg. 2002;105(10):881–5.
- DeLee JC, Clanton TO, Rockwood CA., Jr. Closed treatment of subtrochanteric fractures of the femur in a modified cast-brace. J Bone Joint Surg Am. 1981;63(5):773–9.
- Khosla S, Atkinson EJ, Riggs BL, Melton LJ 3rd. Relationship between body composition and bone mass in women. J Bone Miner Res. 1996 Jun;11(6):857-63.
- Hsu YH, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z, Laird N, Brain JD, Cummings SR, Bouxsein ML, Rosen CJ, Xu X. Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr. 2006 Jan;83:146–154.
- Ensrud KE, Lipschutz RC, Cauley JA, Seeley D, Nevitt MC, Scott J, et al. Body size and hip fracture risk in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Am J Med. 1997;103(4):274–280.
- Giddie J, Sawalha S, Parker M. Retrograde nailing for distal femur fractures in the elderly. SICOT-J. 2015;1:31.
- Neubauer T, Ritter E, Potschka T, Karlbauer A, Wagner M , 56 fractures in 54 elderly patients with a distal femur fracture with a retrograde femoral nail.. Retrograde nailing of femoral fractures. Acta Chir Orthop Traumatol Cech. 2008 Jun;75(3):158-66.
- Andrzejewski K, Panasiuk M, Grzegorzewski A, Synder M. Comparison of knee function in patients with a healed fracture of the femoral shaft fixed with retrograde and antegrade intramedullary nailing. Ortop Traumatol Rehabil. 2013 Oct 31;15(5):395-405.
- Ricci WM, Bellabarba C, Evanoff B, Herscovici D, DiPasquale T, Sanders R. Retrograde versus antegrade nailing of femoral shaft fractures. J Orthop Trauma. 2001 Mar-Apr;15(3):161-9.
Corresponding Author
Dr Rahil Jiwani
Assistant Professor, Department of Orthopedics,
Flat FF2, Hussaini Plaza Apartments, Khoja Colony, Sahyadri Nagar, Vishranbagh, Sangli, 416416
DOI: https://dx.doi.org/10.18535/jmscr/v6i6.66
