Ricci, J Orthop Trauma 2001 - Retrograde versus Antegrade Nailing of Femoral Shaft Fractures - Article Summary

Retrograde versus Antegrade Nailing of Femoral Shaft Fractures

Ricci, Sanders, et al.·J Orthop Trauma·2001·277 citations·Retrospective cohort

Purpose

To compare union rates and complications of retrograde intramedullary nailing of femoral shaft fractures with those of antegrade intramedullary nailing.

Methods

Design: Retrospective.

Setting: Level I trauma center.

Patients:

283 consecutive adult patients with 293 fractures of the femoral shaft who underwent stabilization with antegrade or retrograde inserted femoral nails were studied.
There were 140 retrograde nails and 153 antegrade nails.
12 fractures in 12 patients were excluded (3 in patients who died early in the postoperative period, 3 in patients because of early amputation, 4 in patients who were paraplegic, and 2 in patients who fractured through abnormal bone owing to metastatic carcinoma), leaving 134 fractures treated with retrograde nails and 147 treated with antegrade nails.
104 femurs treated with retrograde nails (Group R) and 94 femurs treated with antegrade nails (Group A) had sufficient follow-up and served as the 2 study groups.
The average clinical follow-up was 23 months (range 6 to 66 months) for Group R and 23 months (range 5 to 64 months) for Group A.
Both groups were comparable with regard to age, gender, number of open fractures, degree of comminution, mode of interlocking (i.e., static or dynamic), and nail diameter (P > 0.05).

Intervention: Retrograde intramedullary nails were inserted through the intercondylar notch of the knee, and antegrade nails were inserted through the piriformis fossa using standard techniques.

Main Outcome Measures: Union, delayed union, nonunion, malunion, and complication rates.

Results

After the index procedure there were no significant differences in healing or incidence of malunion between Group R and Group A (P > 0.05).
Healing after the index procedure occurred in 91 (88 percent) of the femurs in Group R and in 84 (89 percent) of the femurs in Group A.
In Group R, there were 7 delayed unions (7 percent) and 6 nonunions (6 percent).
In Group A, there were 4 delayed unions (4 percent) and 6 nonunions (6 percent).
Healing ultimately occurred in 100 (96 percent) femurs from Group R and in 93 (99 percent) femurs from Group A.
In Group R, there were 11 malunions (11 percent), and in Group A, there were 12 malunions (13 percent).
When patients with ipsilateral knee injuries were excluded, the incidence of knee pain was significantly greater for Group R patients (36 percent) than for Group A patients (9 percent) (P < 0.001).
When patients with ipsilateral hip injuries were excluded, the incidence of hip pain was significantly greater for Group A patients (10 percent) than for Group R patients (4 percent) (P < 0.05).

Conclusions

Retrograde and antegrade nailing techniques provided similar results in union and malunion rates. There were more complications related to the knee after retrograde nailing and more complications related to the hip after antegrade nailing.

Supplemental

Retrograde versus Antegrade Nailing of Femoral Shaft Fractures.

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Retrograde versus Antegrade Nailing of Femoral Shaft Fractures

Ricci, Sanders, et al.·J Orthop Trauma·2001·277 citations·Retrospective cohort

DOI·PubMed

Purpose

To compare union rates and complications of retrograde intramedullary nailing of femoral shaft fractures with those of antegrade intramedullary nailing.

Methods

Design: Retrospective.

Setting: Level I trauma center.

Patients:

283 consecutive adult patients with 293 fractures of the femoral shaft who underwent stabilization with antegrade or retrograde inserted femoral nails were studied.
There were 140 retrograde nails and 153 antegrade nails.
12 fractures in 12 patients were excluded (3 in patients who died early in the postoperative period, 3 in patients because of early amputation, 4 in patients who were paraplegic, and 2 in patients who fractured through abnormal bone owing to metastatic carcinoma), leaving 134 fractures treated with retrograde nails and 147 treated with antegrade nails.
104 femurs treated with retrograde nails (Group R) and 94 femurs treated with antegrade nails (Group A) had sufficient follow-up and served as the 2 study groups.
The average clinical follow-up was 23 months (range 6 to 66 months) for Group R and 23 months (range 5 to 64 months) for Group A.
Both groups were comparable with regard to age, gender, number of open fractures, degree of comminution, mode of interlocking (i.e., static or dynamic), and nail diameter (P > 0.05).

Intervention: Retrograde intramedullary nails were inserted through the intercondylar notch of the knee, and antegrade nails were inserted through the piriformis fossa using standard techniques.

Main Outcome Measures: Union, delayed union, nonunion, malunion, and complication rates.

Results

After the index procedure there were no significant differences in healing or incidence of malunion between Group R and Group A (P > 0.05).
Healing after the index procedure occurred in 91 (88 percent) of the femurs in Group R and in 84 (89 percent) of the femurs in Group A.
In Group R, there were 7 delayed unions (7 percent) and 6 nonunions (6 percent).
In Group A, there were 4 delayed unions (4 percent) and 6 nonunions (6 percent).
Healing ultimately occurred in 100 (96 percent) femurs from Group R and in 93 (99 percent) femurs from Group A.
In Group R, there were 11 malunions (11 percent), and in Group A, there were 12 malunions (13 percent).
When patients with ipsilateral knee injuries were excluded, the incidence of knee pain was significantly greater for Group R patients (36 percent) than for Group A patients (9 percent) (P < 0.001).
When patients with ipsilateral hip injuries were excluded, the incidence of hip pain was significantly greater for Group A patients (10 percent) than for Group R patients (4 percent) (P < 0.05).

Conclusions

Purpose

To compare union rates and complications of retrograde intramedullary nailing of femoral shaft fractures with those of antegrade intramedullary nailing.

Methods

Design: Retrospective.

Setting: Level I trauma center.

Patients:

283 consecutive adult patients with 293 fractures of the femoral shaft who underwent stabilization with antegrade or retrograde inserted femoral nails were studied.
There were 140 retrograde nails and 153 antegrade nails.
12 fractures in 12 patients were excluded (3 in patients who died early in the postoperative period, 3 in patients because of early amputation, 4 in patients who were paraplegic, and 2 in patients who fractured through abnormal bone owing to metastatic carcinoma), leaving 134 fractures treated with retrograde nails and 147 treated with antegrade nails.
104 femurs treated with retrograde nails (Group R) and 94 femurs treated with antegrade nails (Group A) had sufficient follow-up and served as the 2 study groups.
The average clinical follow-up was 23 months (range 6 to 66 months) for Group R and 23 months (range 5 to 64 months) for Group A.
Both groups were comparable with regard to age, gender, number of open fractures, degree of comminution, mode of interlocking (i.e., static or dynamic), and nail diameter (P > 0.05).

Intervention: Retrograde intramedullary nails were inserted through the intercondylar notch of the knee, and antegrade nails were inserted through the piriformis fossa using standard techniques.

Main Outcome Measures: Union, delayed union, nonunion, malunion, and complication rates.

Results

After the index procedure there were no significant differences in healing or incidence of malunion between Group R and Group A (P > 0.05).
Healing after the index procedure occurred in 91 (88 percent) of the femurs in Group R and in 84 (89 percent) of the femurs in Group A.
In Group R, there were 7 delayed unions (7 percent) and 6 nonunions (6 percent).
In Group A, there were 4 delayed unions (4 percent) and 6 nonunions (6 percent).
Healing ultimately occurred in 100 (96 percent) femurs from Group R and in 93 (99 percent) femurs from Group A.
In Group R, there were 11 malunions (11 percent), and in Group A, there were 12 malunions (13 percent).
When patients with ipsilateral knee injuries were excluded, the incidence of knee pain was significantly greater for Group R patients (36 percent) than for Group A patients (9 percent) (P < 0.001).
When patients with ipsilateral hip injuries were excluded, the incidence of hip pain was significantly greater for Group A patients (10 percent) than for Group R patients (4 percent) (P < 0.05).

Conclusions

Purpose

To compare union rates and complications of retrograde intramedullary nailing of femoral shaft fractures with those of antegrade intramedullary nailing.

Methods

Design: Retrospective.

Setting: Level I trauma center.

Patients:

283 consecutive adult patients with 293 fractures of the femoral shaft who underwent stabilization with antegrade or retrograde inserted femoral nails were studied.
There were 140 retrograde nails and 153 antegrade nails.
12 fractures in 12 patients were excluded (3 in patients who died early in the postoperative period, 3 in patients because of early amputation, 4 in patients who were paraplegic, and 2 in patients who fractured through abnormal bone owing to metastatic carcinoma), leaving 134 fractures treated with retrograde nails and 147 treated with antegrade nails.
104 femurs treated with retrograde nails (Group R) and 94 femurs treated with antegrade nails (Group A) had sufficient follow-up and served as the 2 study groups.
The average clinical follow-up was 23 months (range 6 to 66 months) for Group R and 23 months (range 5 to 64 months) for Group A.
Both groups were comparable with regard to age, gender, number of open fractures, degree of comminution, mode of interlocking (i.e., static or dynamic), and nail diameter (P > 0.05).

Intervention: Retrograde intramedullary nails were inserted through the intercondylar notch of the knee, and antegrade nails were inserted through the piriformis fossa using standard techniques.

Main Outcome Measures: Union, delayed union, nonunion, malunion, and complication rates.

Results

After the index procedure there were no significant differences in healing or incidence of malunion between Group R and Group A (P > 0.05).
Healing after the index procedure occurred in 91 (88 percent) of the femurs in Group R and in 84 (89 percent) of the femurs in Group A.
In Group R, there were 7 delayed unions (7 percent) and 6 nonunions (6 percent).
In Group A, there were 4 delayed unions (4 percent) and 6 nonunions (6 percent).
Healing ultimately occurred in 100 (96 percent) femurs from Group R and in 93 (99 percent) femurs from Group A.
In Group R, there were 11 malunions (11 percent), and in Group A, there were 12 malunions (13 percent).
When patients with ipsilateral knee injuries were excluded, the incidence of knee pain was significantly greater for Group R patients (36 percent) than for Group A patients (9 percent) (P < 0.001).
When patients with ipsilateral hip injuries were excluded, the incidence of hip pain was significantly greater for Group A patients (10 percent) than for Group R patients (4 percent) (P < 0.05).