A prospective study of retrograde nailing for distal third femoral shaft fractures

Abstract

Background: To evaluate the postoperative knee range of motion and results of unreamed retrograde nailing for distal third femoral shaft fractures.Methods: Between June 2019 and June 2021 inclusive, a consecutive series of 20 patients who underwent retrograde nailing were prospectively evaluated. Outcome measures were union time, initiation of weight bearing, deformity and shortening, functional length of the nail, knee function assessed using a modified knee society knee score. Correlations between union time and other variables were also studied.Results: In these patients 18 (90%) of the 20 fractures achieved union, of which 4 underwent dynamisation; the mean union time for the other 18 fractures was 3.1 months. Angular malalignment was present in 2 patients and shortening in 3 others. There was negligible correlation between union time and variables of nail-canal diameter mismatch, functional length of nail, fracture geometry, or initiation of partial weight bearing ambulation. Knee flexion of more than 100 degrees was achieved in 19 patients. 14 patients had anterior knee pain and 7 had instability in early phases of ambulation. By the end of one year, excellent or good scores for pain and function were recorded in 95% and 86% respectively of the 20 patients.Conclusions: In view of such favourable union rates and no significant deterioration in overall knee joint function, at best retrograde nailing is a reliable alternative in the management of selected complicated fractures of the distal femoral shaft.