Retrograde intramedullary interlocking nailing in fractures of the distal femur

Objectives: We evaluated retrograde locked intramedullary nail applications in patients with distal femur fractures. Methods: Distal femur fractures of 16 patients (11 males, 5 fe¬males; mean age 45 years; range 25 to 69 years) were treated with retrograde locked intramedullary nailing. One patient had bilateral fractures. According to the AO classification, the frac¬tures were A1 (n=8), A2 (n=4), A3 (n=4), and C1 (n=1). There were 13 closed (76.5%), and four open (23.5%) fractures. The mean time to surgery was 10 days (range 2 to 20 days). Open technique was used for nine fractures, and percutaneous tech¬nique for eight fractures. Preoperatively, three patients with a floating knee were evaluated with magnetic resonance imag¬ing and were found to have a ruptured cruciate ligament. All patients underwent intraoperative knee examination, which showed a ruptured cruciate ligament in five patients. Functional results were assessed using the modified HSS (Hospital for Spe¬cial Surgery) knee rating scale at the end of a mean follow-up period of 32.6 months (range (12 to 68 months). Results: The mean time to union was 25 weeks (range 14 to 42 weeks). One patient had delayed union (42 weeks). Joint range of motion was normal in three knees (17.7%), was 100 to 110° in nine knees (52.9%), 80° in four knees (23.5%), and below 80° in one knee (5.9%). According to the modi¬fied HSS knee scale, the results were excellent in five femurs (29.4%), good in six femurs (35.3%), moderate in five femurs, and poor in one femur (5.9%). Postoperative radiographic exam¬ination showed varus angulation (10°) in four patients (23.5%), and posterior angulation (10-20°) in four patients. In one patient, healing occurred with extreme deformation (30° posterior an¬gulation). None of the patients experienced wound site problems or infections. One patient developed deep vein thrombosis in the early postoperative period. Conclusion: Treatment of distal femur fractures with retro¬grade locked intramedullary nailing yields satisfactory results in adults.