Abstract: The distal femur is an area that is particularly vulnerable to the dangers of our modern life styles and high velocity methods of transportation. Among young patients, fractures of the distal femur usually are a component of multiple traumas sustained through high – velocity, high-impact injuries such as motor vehicle accidents or fall from a height.
Objectives: To analyze the functional outcome of distal femoral fractures treated by retrograde intramedullary nailing.
Materials and Methods: Between January 2016 and June 2018, 11 distal femoral fractures in 10 patients were operated using retrograde intramedullary nail at tertiary care hospital Surat. There were 7 (70%) males, & 3 (30%) were females; Age was ranging 18-74 years, with an average of 43.4 years. 7 patients were due to polytrauma.
Fractures were classified according to Muller’s classification, 4.76% were Type A1, 14.8% were Type A2, 42.8% were Type A3, 9.52% were Type C1, 14,28% were Type C2 and 14.28% were Type C3. All the cases were operated with retrograde intramedullary nailing using patellar splitting approach.
Observations: The mean operative time was 19 minutes (16 to 240 minutes). Primary bone grafting was done in 2 cases (19%), Open reduction was done in 2 cases. Post operatively knee mobilization was done using CPM. The average follow up interval was 13 months (3 to 36) months.
Results: All fractures healed by 4 months range 3 to 3.5 months. The mean knee range of movements was 980 (800 to 1400). There was deep infection in one case, shortening more than 2 cm in one case, 80 valgus angulation in one case, anterior knee pain in 1 case and implant protruding to knee joint in 1 case. There were no late mechanical failures of the implant.
Neer’s knee rating system was used to evaluate the function, there were 3 (30%) excellent, 5 (50%) satisfactory results, 1 (5%) was unsatisfactory results and 1(5%) of the case failed. The results correlated with age of the patient and the presence of an intra- articular fracture.
Conclusion: This study shows distal femoral fractures were common in males due to high velocity injuries. Retrograde intramedullary nailing is an excellent technique for management of distal femoral fractures since there is less soft tissue dissection. The preferred portal of entry can be reached quickly & effectively, shortens the duration of surgery, decreases the need for bone grafting, high union rate and good knee range of movements. Complications were few, which includes infection, shortening, angulation and anterior knee pain.
