Outcome analysis of retrograde nailing for surgical stabilization of distal 1/3rd fracture shaft femur: A hospital based study

Abstract

Background: The distal 1/3rd femoral fractures constitute 6% of all femoral fractures. These fractures pose a great challenge in management due to the involvement of soft tissue injury, intra-articular extension, and injury to the extensor mechanism. The debates on the choice of implant for distal femoral fractures are on-going among orthopedic surgeons. Retrograde approach through the femoral intercondylar notch has been popularized in the recent years as an alternative to antegrade nailing. Surgical treatment of periarticular and intra-articular fractures of the distal femur pose a significant challenge to the orthopedic surgeon. The primary goal of surgical treatment remains: restoration of the articular surface to the femoral shaft, while maintaining enough stability and alignment to enable early range of motion and rehabilitation. The aim of this study was to investigate its effectiveness in fixation of distal 1/3rd fracture of femur with special emphasis on the outcome and inherent surgical challenges. Material & Methods: A prospective study of 20 patients with fracture femur diaphysial distal one third were treated by retrograde nailing, from January 2019 to December 2020, after obtaining required approval from the Institutional ethics committee. All the patients were followed till fracture union and evaluated on the basis of demography, duration of healing, complications and surgical challenges. Results: In the present study, out of 20 study subjects there were 7 patients (35%) in the age group of 31-40 yrs followed by 6 patients (30%) were in the age group of 31-40 yrs, 4 patients (20%) were in the age group of 41-50 yrs, 2 patients (10%) in the age group of 51-60 yrs with mean age of the patients was 43.6 ± 17.67 years. There were 17 patients (85%) male and 3 patients (15%) female. The mode of injury in case of majority of the patients had RTA [road traffic accidents] 11 patients (55%), followed by fall from height 5 patients (25%), sports injury 2 patients (10%) and domestic injuries 2 patients (10%). Mean time from the injury to operation was 3 days. The mean duration of the surgery was 100 mins. Majority of the patients 16 (80%) had isolated femoral fractures while others 4 patients (20%) had polytrauma. Mean time of the fracture healing was 18.5 weeks [SD ± 6.75]. In the present study we have observed that the post-operative knee range of motion (ROM) achieved; 8 patients (40%) had 125º, 4 patients (20%) had 135º, 2 patients (10%) had 140º, 2 patients (10%) had 105º, 3 patients (10%) had 110º, 1 patient (5%) had 115º, and with mean of 123.75º post-operatively. Conclusion: Retrograde nailing for surgical stabilization of distal 1/3rd fracture shaft femur is adequate treatment options for distal femur fractures. Locked plating can be used for all distal femur fractures including complex type C fractures, periprosthetic fractures, as well as osteoporotic fractures. IM nailing provides favorable stability and can be successfully implanted in bilateral or multisegmental fractures of the lower extremity as well as in extra-articular fractures. Clinical outcome largely depends on surgical technique rather than on the choice of implant.