Analytic study of functional outcome of retrograde intramedullary nailing for distal femoral fractures in adults

<p class="abstract"><strong>Background: </strong>The purpose of this Study was to evaluate the clinical and functional outcome of retrograde intramedullary nailing for distal femur fractures.</p><p class="abstract"><strong>Methods: </strong>This 2 years observational study was done between December 2018 to January 2021, 60 patients with distal femoral fractures were surgically treated at our hospital using retrograde intramedullary nail. The patient was placed supine on fracture table with affected limb flexed to 60 degrees. Through a Transpatellar approach, the nail was introduced in 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 functional outcome with various types of fractures.</p><p class="abstract"><strong>Results: </strong>All the fractures in the present study healed at an average of 13 weeks. However 25 to 40% of these patients underwent bone grafting primarily with reports of delayed union and non-union. Shortening occurred in two patients (3.33%) did affect the final functional outcome. average range of motion is 120 deg. for all fractures, 119 deg. for extra-articular fractures and 118 deg. for intra-articular fractures. Infection rates are low (0% to 8%).</p><p class="abstract"><strong>Conclusions: </strong>The study shows distal femoral fractures were common due to high velocity injuries, retrograde nailing is an excellent technique for management of distal femoral fractures as it promotes high rate of fracture union with less complications.</p>

Paediatric Radial Neck Fracture Fixation by Metaizeau Technique - Surgical Technique and Outcome

BACKGROUND Radial neck fractures in children are serious injuries with frequent sequelae when the tilt exceeds 60 degrees. Conservative treatment is often inadequate in such cases and open reduction may produce iatrogenic complications. Displaced radial neck fractures in the paediatric population can be treated with retrograde intramedullary nailing of the radius (the Metaizeau technique). This method allows early post-operative movement and thus has high functional outcome. The purpose of this case series was to evaluate the functional outcome of Metaizeau technique. METHODS This is a prospective study in which follow-up of 9 cases with radial neck fracture treated with Metaizeau technique was done. Clinical and radiological evaluation was done at 2 weeks, 4 weeks, 6 weeks and 6 months. Active range of motion of flexion and extension at elbow and forearm rotation was noted at 6 weeks along with pain score and Mayo Elbow Performance Score (MEPS). Radiological assessment was also done at 6 weeks regarding union. RESULTS 8 out of 9 cases had radiological union at 6 weeks. 1 case was lost to follow-up. Excellent result was obtained in all 8 cases. Range of flexion-extension, supinationpronation were identical in all 8 cases. 1 case developed pressure bursitis at entry site. CONCLUSIONS Metaizeau technique for radial neck fracture fixation is simple, safe, soft tissue sparing, minimally invasive technique giving excellent functional and cosmetic results with minimal complication. KEYWORDS Metaizeau Technique, Retrograde Intramedullary Nailing, Radial Neck Fracture, MEPS

Application of a double reverse traction repositor in the retrograde intramedullary nailing of distal femur fractures

Objective The purpose of this prospective study was to introduce the application of a double reverse traction repositor (DRTR) in the retrograde intramedullary nailing (RE-IMN) of AO/OTA 33A distal femur fractures. Patients and methods A total of 27 patients with AO/OTA type 33A distal femur fractures who were admitted from January 2015 to May 2017 to a level I trauma center of a tertiary university hospital were enrolled in this prospective study. A DRTR was used to facilitate RE-IMN for the reduction of distal femur fractures in all patients. The demographic and fracture characteristics, surgical data, postoperative complications, and prognostic indicators of 24 patients were recorded. Results The DRTR helped achieve and maintain the reduction of all distal femur fractures in the present study. All surgeries were conducted by closed reduction, and excellent alignment was observed in the postoperative X-ray images. In the present study, 18 males and 6 females were included, and the average age of all patients was 51.3 years (range, 24–68 years). The mean operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of postoperative hospital stay were 137 min (range from 80 to 210 min), 320 ml (range from 200 to 600 ml), 28 (from 24 to 33), and 9 days (from 5 to 14 days), respectively. Eleven patients were found to have postoperative deep venous thrombosis before discharge. No cases of wound infection were observed. No cases of nonunion or malunion were observed. The average follow-up duration was 21 months (18–30 months). The average HHS, LKFS, and VAS scores at the 1-year follow-up were 89.9 (86–97), 79.1 (75–87), and 2.1 (from 0 to 5). No complications associated with DRTR were found. Conclusions A DRTR can be successfully applied in the treatment of distal femur fractures with RE-IMN, and it can not only help achieve or maintain the reduction of distal femur fractures with closed methods but also promote fixation with RE-IMN.

Locked compression plating versus retrograde intramedullary nailing in the treatment of periprosthetic supracondylar knee fractures: a systematic review and meta-analysis

Background Periprosthetic fractures of the distal femur above a total knee arthroplasty (TKA) have traditionally been managed by locking compression plating (LCP). This technique is technically demanding and is associated with high rates of non-union and revision. More recently, retrograde intramedullary nailing (RIMN) has been proposed as an acceptable alternative. This meta-analysis aims to evaluate clinical outcomes in patients with periprosthetic supracondylar femoral fractures who were treated with LCP and RIMN. Methods An up-to-date literature search was carried out using the pre-defined search strategy. All studies that met the inclusion criteria were assessed for methodological quality with the Cochrane’s collaboration tool. Operative time, functional score, time-to-union, non-union rates and revision rates were all considered. Conclusion Ten studies with a total of 531 periprosthetic fractures were included. This meta-analysis has suggested that there is no significant difference in any of the outcome measures assessed. Further, more extensive literature is required on the subject to draw more robust conclusions.