Abstract
Introduction
To compare the union rates and post-operative mobility of antegrade intramedullary nailing of osteoporotic traumatic supracondylar femoral fractures (AO classification A to C2) with those of plating.
Materials/Methods
We studied any traumatic intra or extra-articular supracondylar femoral fracture from 2005–2010. Patients were either admitted directly to our level 1 trauma centre or were referred from another hospital. Nineteen patients were identified, consisting of primarily fixation with five antegrade nails and fourteen plates. We defined osteoporotic bone as being present in anyone over sixty years old or who had a clinical diagnosis. One nail and six plates were excluded due to young age or fracture severity. This left four nails, six less invasive stabilisation system plates and two dynamic condylar screw plates. Both groups were comparable with respect to age, sex and AO fracture classification.
Results
There was a significant difference in achieving union between the two groups (p=0.040). Union occurred within three months in all four fractures in the nail group but only three fractures (38%) united after primary fixation in the plate group. There were two failures due to screw pullout, one failure due to screw breakage, one broken plate after delayed-union and one screw breakage after non-union. The patients in the nail group had better mobility and less pain than the plate group but the difference was not statistically significant.
Conclusion
We have shown that for patients with osteoporotic, supracondylar femoral fractures, fixation with an antegrade IM nail provides significantly better healing compared to plate fixation.
