Operative management of distal third femur fractures using supercondylar nail

Author(s): Dr. Pradeep Natikar, Dr. Sanjeev Chincholi

Abstract: Background and objectives: Distal third femur fractures are often difficult to treat and they are notorious. For many complications like knee stiffness, quadricep wasting, knee instability, malunion, non-union, joint incongruity, shortening, prolonged bed-rest and post-traumatic osteoarthritis after treated conservatively. Intramedullary retrograde nailing reduces the tendency of varus movement at fracture site and bending movement substantially reduced. Failure of fixation in osteoporotic bone should be less. Retrograde supracondylar nail has got advantages of preservation of fracture hematoma, decreased blood loss, minimal soft tissue dissection and other complications like knee-stiffness, less operative time and reduced rate of infection, mal union, non-union, quadricep wasting, prolonged bed rest. Objectives of this study is to evaluate the results of supracondylar femur fracture treated by open/ closed reduction and internal fixation using retrograde intramedullary supracondylar nail in respect of knee-flexion, early weight bearing and return to pre-fracture state of patient. Methods: 25 patients with supracondylar femur fracture were studied. RIS nail was inserted through intercondylar notch. These nails have advantage of being load shearing devices, requiring little soft tissue dissection, infrequently needing bone grafting and technically easier. Preserving fracture hematoma, decreased blood loss, less operative time and decreased infection. Results: In 25 patients, male predominate (88%) in this study. RTA was the chief cause of fracture. Surgery were performed within 6.92 days average, There were 7 open of which 5 gustilo type 2, 2 gustilo type3 and 18 closed type of fracture radiological union was possible in 16.16 weeks. Average patient was followed up for 11.48months. Average knee flexion of 100°. There were 8knee pain, 4shortening, 3 with protruding nail into knee joint, 1delayed union, 2 superficial infection. Using Neer’s scoring system there were 56% excellent, 16% good, 24% fair, 1% poor results. Conclusion: Retrograde intramedullary nailing is a good fixation system for supracondylar femur fractures with less operative time and blood loss. By closed reduction, not disturbing fracture hematoma and even in open reduction less soft tissue dissection and thus reducing complications like infection, stiffness, distal screw related local symptom is a common problem and is related to implant and technique and has a definite learning curve. Utmost aseptic precaution great care required to prevent infection.