Abstract: Introduction: The distal third femoral fractures constitute 6% of all femoral fractures. These fractures pose a great challenge in management due to the involvement of soft tissue injury, intraarticular extension, and injury to the extensor mechanism. The debates on the choice of implant for distal third femoral fractures are on-going among orthopedic surgeons. Controversy remains regarding the optimum device for distal femur fixation.
Objectives: To evaluate and compare the clinical and the radiological outcomes of distal third femoral fractures stabilised using retrograde nailing constructs.
Materials and Methods: This one and half -year prospective observational study includes all patients with fractures of distal femur who underwent retrograde intramedullary interlocking nailing. The patient was placed supine on fracture table with the affected limb flexed to 60o. Through a transpatellar approach, the nail was introduced in a retrograde method after serial reaming. Postoperatively knee range of motion was started immediately and weight-bearing was progressed after signs of fracture union were noted on x-rays. The outcome was evaluated for time taken for fracture union, complications and secondary procedures, knee range of motion and function at 1 year follow up using modified kneerating scale of the hospital for special surgery.
Observations and Results: There were 20 patients who underwent retrograde intramedullary nailing for fractures of distal femur during the study period. According to AO/ASIF system, fractures were classified as A1 (n=15), A2 (n=3), and A3 (n=3). In 15 patients, fracture united without complications or secondary procedures. Fractures united at a mean time of 18.4 weeks. There were no varus or valgus malalignments but one patient had significant limb shortening. At the end of 1 year, excellent to good functional outcome was noted in 81% of patients.
Conclusion: Retrograde distal femoral nailing for AO/ASIF type A and type C distal third femoral fractures are a proven and reliable method of fixation͘ This safe, successful, reliable and useful technique should find a place in the armamentarium of every orthopedic surgeon dealing with distal third femoral fractures that initially requires attention to details of the technique to prevent complications and to improve the quality of life.
