J Korean Fract Soc.  2007 Apr;20(2):135-140. 10.12671/jkfs.2007.20.2.135.

Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture

• Oh CW
• Oh JK
• Min WK
• Kim SY
• Baek SH
• Park BC
• Ahn HS
• Kim TG

• KMID: 2295570
• DOI: http://doi.org/10.12671/jkfs.2007.20.2.135

Abstract

PURPOSE
To compare retrospectively the antegrade and retrograde nailing in the management of ipsilateral femoral neck and shaft fractures.
MATERIALS AND METHODS
Thirty-two patients (thirty-three injuries) were included in this study. Mean age of patients was 38 years-old in the antegrade nailing group (16 injuries) and 44 years-old in the retrograde nailing group (17 injuries). We compared the union of fractures and complications between two groups, and investigated the influencing factors.
RESULTS
Femoral shaft fracture was united in 10 cases (63%) of antegrade group and 12 cases (71%) of retrograde group, at 28.2 and 27.3 weeks respectively. Nonunion was more prevalent in Winquist-Hansen III and IV (5 in antegrade nailing, 3 in retrograde nailing) than I and II. Femoral neck fracture was united with 1 case of nonunion in each group. Nonunion developed from Garden stage IV, but fractures of Garden stage I and II united regardless of methods.
CONCLUSION
In ipsilateral femoral neck and shaft fractures, the kinds of methods did not affect the results of shaft fractures. Minimally displaced neck fractures also were not influenced by kinds of methods, but retrograde nailing may have a benefit in fixing the displaced neck fractures

Keyword

Ipsilateral femoral neck and shaft fractures; Retrograde nailing; Antegrade nailing

MeSH Terms

Agriculture
Femoral Neck Fractures
Femur Neck
Humans
Methods*
Neck*
Retrospective Studies

Figure

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  Fig. 1 (A) A 29-year-male with femur shaft fracture. (B) Postoperatively, femur neck fracture was found on the radiograph (arrow) and CT image. (C) Fourteen days after initial operation, fixation was done with three screws anterior to the femoral nail.

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  Fig. 2 (A) At 2 month, femoral neck fracture healed and callus is forming on the shaft fracture. (B) At 6 month, all fractures healed uneventfully without leg length discrepancy.

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  Fig. 3 (A) A 61-year-man with ipsilateral fractures of femoral shaft and neck. (B) Retrograde nailing of the shaft and screw fixation of the neck was done.

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  Fig. 4 At 5 month, fractures healed uneventfully.

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  Fig. 5 (A) 24 years old female with femur shaft fracture and ipsilateral displaced neck fracture. (B) Antegrade nailing and screw fixation of the neck was done. Due to the preinserted nail, there were some difficulties in screw fixation.

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  Fig. 6 (A) At 3 months after surgery, the neck fracture displaced with loosening of the screws. (B) Using dynamic hip screw and dynamic compression plate, revision procedure was done on both fractures. (C) At 7 month after 2nd operation, both fractures healed.

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