Retrograde intramedullary nailing of open femoral shaft fractures: a retrospective case series.

BACKGROUND

Nailing of open femur fractures has been described, but the literature on this subject often used antegrade nailing techniques. A retrograde nailing technique carries the risk of contamination and infection of the knee, infection, and nonunion. The purpose of this study was to have a case series examining the intermediate term outcome of retrograde nailing of open femur fractures.

METHODS

A retrospective review of all open femur fractures treated between 2008 and 2010 at a Level II trauma center was performed. Demographic and injury patterns were reviewed for the 35 patients who were treated with retrograde nailing. The main outcome measures evaluated were infection (knee or femur) and nonunion.

RESULTS

There were 11 grade I, 18 grade II, and 6 grade IIIA fractures (no IIIB or IIIC injuries). Healing occurred in 34 of 35 fractures with 1 (3%) nonunion and 2 (6%) deep infections, both occurring in IIIA fractures. There were no cases of knee joint infections, but two patients (6%) developed arthrofibrosis requiring manipulation. Implant removal of a prominent screw was required in one patient.

CONCLUSION

Early retrograde nailing of open femur fractures has infection and healing rates consistent with existing literature. There seems to be little risk for knee infection, but the increased incidence of arthrofibrosis requiring manipulation is higher than previously published. These findings suggest that early retrograde nailing may be considered an acceptable treatment option for open femur fractures.

LEVEL OF EVIDENCE: IV, case series.