Abstract
Introduction: Nailing of the femoral shaft fractures has almost exclusively been done through the antegrade approach. This involves the use of a traction table and location of the entry point piriform fossa can be difficult especially in the obese or well-built patient. The set-up and operative time and blood loss can be considerable. We conducted a prospective study of nailing of femoral fractures, using the retrograde approach (through the knee joint) to measure the operating time, blood loss and knee function. A purpose built retrograde system was used (ART Nail ® ACE Medical Company-El Segundo, California)
Materials & Methods: Seventeen patients who had a femoral shaft fracture, either as an isolated injury, or with associated with other injuries were nailed using the Art Nail, using the retrograde approach. The patients were placed on a radiolucent table, with a bolster place under the knee joint. A stienmann pin was inserted into the ipsilateral tibia 1” inferior and posterior to the tibial tubercle. This was used to apply traction manually by an assistant. The surgical approach was to split the patella tendon and the knee joint was entered. Using a light source, the nail entry point at the intercondylar notch, 7mm anterior to the PCL, is located. The rest of the operative procedure was done according to the operative manual. Blood loss was estimated by the anaesthesiologist. A drain was inserted into the knee joint after a through wash-out and continuos passive motion was started when the drain was removed on the 2nd postoperative day.
Results: Fourteen had a single fracture while 3 had other associated fractures. The age range of was 28 to 67 years. Operative time was 60–100 minutes with blood loss ranging from 50–600 mls,with the median at 200mls. Post-operative drainage was 10–335 mls with median at 100mls. One patient developed distal deep vein thrombosis. Two patients were lost to follow-up. Union occurred at 12–20 weeks in fourteen patients, Two patients had to undergo dynamisation of the nail, one of which required a bone grafting to achieve union at 24 weeks. Two patients had a 1cm shortening of the limb and there were no malrotations. Two patients had < 5 degree medial–lateral angulation, on X-ray. At six months follow-up, fourteen patients had full range of motion at the knee joint, while one patient who had chondrocalcinosis had range of motion from 0 to 90 degrees. . The follow-up period is from 10–26 months. No patient complained of pain or instability of the knee joint
Conclusion: The retrograde approach is a safe and quick method of nailing femoral shaft fractures with no medium term effects on the knee joint.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
