Functional and Radiological Outcome of Retrograde Interlocking Nailing in Distal Femur Extra Articular Fracture

Abstract

Background: Among the several joints that bear the body's weight, the knee is particularly  difficult to understand due to its anatomical peculiarities. Damage to the knee can change its stability, alignment, and mobility, which can hinder function. Fractures of the distal femur make up 4-6% of all femoral fractures, yet they only account for less than 1% of all fractures. For these fractures, antegrade nailing is seen to be the preferred course of action. Nonetheless, difficulties in maintaining good central location of the nail in a very wide medullary canal at this level  led to the creation of the retrograde process.

Objective: The objective of this study was to evaluate the functional and radiological outcome in distal femur fractures fixed with retrograde nailing technique.

Methods: A prospective descriptive case series conducted in Department of Orthopedic Surgery, Lahore General Hospital Lahore of 47 patients with closed, isolated distal femur fractures, aged 18-60. Records were maintained for the side of the fractured bone, infection, radiological union time, start of weight bearing, and function outcome. Retrograde nailing (RN) was done in all patients after spinal anesthesia. Following the procedure, patients were followed up in the outpatient department (OPD) in the 2nd, 6th,12th, 16th, 20th, 24th, 36th & 48th weeks. second, sixth, twelve, sixteen, twenty, twenty-four, thirty-six, and forty-eight. Clinical observations recorded local infection. The radiological union scale (RUST) was used to observe union, and a modified American knee society score was used to measure functional result.

Results: Thirty (63.8%) of the 47 patients were men, and seventeen (36.2%) were women. The patients' mean age was 38.8±6.19 years. There were 02 cases of infections (4.24%). The union rate with the retrograde nailing technique was 42 (91.5%). Of the 47 patients, 25 (53.2%) had good functional outcomes, 09 (19.2%) had good , 10 (21.3%) had average , and 03 (6.3%) had poor scores according to AKSS.

Conclusion: Retrograde nails provide a dependable alternative for managing complex distal femur shaft fractures, with a low infection incidence, satisfactory functional and radiological outcome.