Interlocking Intramedullary Nailing for Supracondylar & Intercondylar Fracture of the Distal Part of the Femur

Suh, Kuen Tak; Yoo, Chong Il; Song, Jin Heun

Abstract

The conventional therapy for supracondylar fracture of the femur is open reduction and internal fixation with plate and screws. But, wide dissection of the thigh with the following devascularization of the distal femur caused a high incidence of complications like joint stiffness, delayed union, nonunion, infection and loosening or breakage of plate and screws. On the contrary, interlocking intramedullary nailing does not need the exposure of the fracture so that soft tissue dissection and devascularization can be minimized. Undoubtedly, rapid healing by abundant formation of callus is promoted, irrespective of the degree of comminution. We reviewed 9 cases of interlocking intramedullary nailing for supracondylar and intercondylar frtures of the distal part of the femur at Pusan National University Hospital from November 1993 to December 1995. The mean time to union was 14 weeks (range, 11-23weeks). According to Rating System of Neer et al., excellent was 7 cases, satisfactory in 1 case and unsatisfactory in 1 case. Interlocking intramedullary nailing was applied to Type A, C1 and C2 of the AO classification but considered difficult to apply to Type B and C3. For the firm fixation and the prevention of nail breakage, the nail should be inserted deepest in order to place two distal screws as distally as possible from the fracture site. If necessary the distal tip of nail was cut off for use. Interlocking intramedullary nailing does not need the exposure of fracture site. Satisfactory result could be obtained by reducing complications such as joint stiffness, delayed union, nonunion, infection and breakage of implants caused by wide dissection of the thigh with the following devascularization of the distal femur for the open reduction and internal fixation with plate and screws. It also could be obtained by performing early ROM exercise with firm, fixation.