J Korean Fract Soc.  2018 Apr;31(2):50-56. 10.12671/jkfs.2018.31.2.50.

Factors Affecting Posterior Angulation in Retrograde Intramedullary Nailing for Distal Femoral Fractures

• Lee H
• Jeong JH
• Kim MS
• Kim BS

• KMID: 2409760
• DOI: http://doi.org/10.12671/jkfs.2018.31.2.50

Abstract

PURPOSE
To analyze the factors that cause a posterior angulatory deformity in the retrograde intramedullary nailing of distal femoral fractures.
MATERIALS AND METHODS
Fifty-five patients with distal femur fractures who were treated with retrograde intramedullary nailing were enrolled in this study. They were followed-up for at least one year postoperatively. The posterior angulatory deformity was evaluated according to the fracture location, pattern, and insertion point and the insertion point was compared with the ideal point derived from the radiographs of 100 normal adults. The correlation between the posterior angulation and the entry point of the nail was analyzed.
RESULTS
The posterior angulation was similar in terms of the fracture location; a meaningful difference was noted among the fracture patterns (p=0.047). The posterior angulation was significantly greater when the entry point was located more posteriorly, accepting a malreduced state (p=0.012).
CONCLUSION
Posterior angulation was smaller in the transverse fracture and the posterior location of the entry point from the apex of the Blumensaat's line increased the posterior angulation.

Keyword

Fracture; Distal femur; Retrograde intramedullary nailing

MeSH Terms

Adult
Congenital Abnormalities
Femoral Fractures*
Femur
Fracture Fixation, Intramedullary*
Humans

Figure

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  Fig. 1. Method of measuring the distance between the intramedullary center line and apex of the Blumensaat's line: (A) practical measurement, (B) schematic drawing.

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  Fig. 2. Entry point of the retrograde intramedullary nail, which could affect the posterior angulation of the fracture: (A) The 8.16 mm anterior location of entry point with no posterior angulation of fracture site was observed. (B) The 7.81 mm posterior location of entry point with posterior angulation.

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  Fig. 3. Method for measuring the posterior angulation of the fracture site: That could be measured from the angle between an intramedullary center line of the distal fragment and that of the proximal fragment. This patient had malunion of 12.6o posterior angulation.

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  Fig. 4. Fracture level as a factor that could affect the posterior angulation of the fracture: (A) supracondylar level (AO 33 type), (B) distal one third level of femoral shaft (AO 32 type).

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  Fig. 5. Facture pattern as a factor that could affect the posterior angulation of a fracture: (A) transverse type, (B) oblique type, (C) spiral type, and (D) comminuted type.

Reference

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