Clin Orthop Surg.  2012 Dec;4(4):307-312. 10.4055/cios.2012.4.4.307.

Retrograde Intramedullary Nailing for Distal Femur Fracture with Osteoporosis

• Kim J
• Kang SB
• Nam K
• Rhee SH
• Won JW
• Han HS

• KMID: 1719299
• DOI: http://doi.org/10.4055/cios.2012.4.4.307

Abstract

BACKGROUND
The incidence of distal femur fracture in the elderly has been increasing recently, and commonly occurs with osteoporosis. Retrograde intramedullary nailing has been considered a good surgical option for distal femur fracture. The purpose of the present study was to present our surgical results with retrograde intramedullary nailing for distal femur fractures with osteoporosis.
METHODS
Thirteen patients diagnosed with extra-articular distal femur fracture and osteoporosis and managed with retrograde intramedullary nailing were retrospectively reviewed. Cement augmentation was used in four patients, shape memory alloy was used in eight patients and both were used in one patient. All patients were followed up for more than 2 years. Radiologic alignments. were scored and Tegner and the Lysholm activity score was used for a functional assessment.
RESULTS
The average time to clinical union was 13 weeks (range, 10 to 15 weeks). In 12 of our cases, the total alignment scores were excellent. At the last follow-up, the mean range of motion was 116degrees (range, 110degrees to 125degrees). The average functional score at postoperative 1 year was 2.6 (range, 1 to 5).
CONCLUSIONS
Retrograde intramedullary nailing is a good surgical option for distal femur fracture with osteoporosis. Cement augmentation and shape memory alloy can also be used for added mechanical stability. This surgical technique is very useful for distal femur fracture with osteoporosis as it promotes fracture healing and early rehabilitation.

Keyword

Distal femur fracture; Osteoporosis; Intramedullary nailing; Cement augmentation; Shape memory alloy

MeSH Terms

Aged
Aged, 80 and over
Alloys
Bone Cements
Female
Femoral Fractures/pathology/radiography/*surgery
Femur/pathology/radiography
Fracture Fixation, Intramedullary/instrumentation/*methods
Humans
Male
Osteoporosis, Postmenopausal/*pathology
Osteoporotic Fractures/pathology/radiography/*surgery
Range of Motion, Articular
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 (A) Preoperative radiographs of the left knee in an 81-year-old woman. (B) Radiographs taken 1 year after surgery. We performed retrograde intramedullary nailing and used shape memory alloy to reinforce mechanical stability. Bony union was achieved without complication.

• 

  Fig. 2 (A) Preoperative radiographs of the right knee in a 71-year-old woman. (B) Radiographs taken 1 year after surgery. We performed retrograde intramedullary nailing with cement augmentation. We achieved good mechanical stability of the bone implant construct and recommended early rehabilitation.

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  Fig. 3 Intraoperative photograph of cement augmentation. There were anterior cortical defects in the distal femur and comminution in the medial aspect of the distal fragment. We performed cement augmentation in the anterior and medial aspect of the distal femur for mechancial stability and prevention of loosening of the interlocking screw.

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