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International Orthopaedics

Published in:

01-03-2018 | Original Paper

The antegrade angle-stable locking intramedullary nail for type-C distal femoral fractures: a thirty four case experience

Authors: Zhihui Zhao, Yi Li, Kifayat Ullah, Basanta Sapkota, Hongbin Bi, Yongqing Wang

Published in: International Orthopaedics | Issue 3/2018

Abstract

Introduction

This is a retrospective study that provides initial experience and verifies the effectiveness of the newly-designed antegrade interlocking angle-stable intramedullary nail (IAIN) combined with half-threaded cancellous screws in the management of type-C (AO/OTA classification) distal femoral fractures.

Methods

During a period of 30 months, 34 patients (mean age 43.1 years) with type-C (AO/OTA classification) fractures of the distal femur were treated with IAIN and half-threaded cancellous screws were reviewed. Peri-operative and post-operative parameters were analyzed.

Results

All of the fractures healed in a mean time of 12.6 weeks with no incidences of malunion, nonunion or infection. No secondary failure of fixation occurred. Partial weight bearing was initiated in an average of 7.4 weeks post-operatively, with full weight bearing initiated in 13.8 weeks. All of the patients, except for one, gained full extension. The mean flexion of the knee joint was 110.1°, while the mean Hospital for Special Surgery (HSS) knee score was 85.2.

Conclusion

The IAIN and half-threaded cancellous screws provided a reliable fixation that facilitated uncomplicated outcomes and uneventful early mobilization in treating type-C fractures of the distal femur.

Smith JRA, Halliday R, Aquilina AL et al (2015) Distal femoral fractures: the need to review the standard of care. Injury 46(6):1084–1088. https://doi.org/10.1016/j.injury.2015.02.016 CrossRefPubMed

Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697. https://doi.org/10.1016/j.injury.2006.04.130 CrossRefPubMed

Wähnert D, Hoffmeier K, Fröber R et al (2011) Distal femur fractures of the elderly—different treatment options in a biomechanical comparison. Injury 42(7):655–659. https://doi.org/10.1016/j.injury.2010.09.009 CrossRefPubMed

Garnavos C, Lygdas P, Lasanianos NG (2012) Retrograde nailing and compression bolts in the treatment of type C distal femoral fractures. Injury 43(7):1170–1175. https://doi.org/10.1016/j.injury.2012.03.023 CrossRefPubMed

Kao FC, Tu YK, Su JY et al (2009) Treatment of distal femoral fracture by a minimally invasive percutaneous plate osteosynthesis: comparison between the dynamic condylar screwand the less invasive stabilization system. J Trauma 67(4):719–726. https://doi.org/10.1097/TA.0b013e31819d9cb2 CrossRefPubMed

Langford J, Burgess A (2009) Nailing of proximal and distal fractures of the femur: limitations and techniques. J Ortho Trauma 23:S22–S25. https://doi.org/10.1097/BOT.0b013e31819f2797 CrossRef

Heiney JP, Barnett MD, Vrabec GA et al (2009) Distal femoral fixation: a biomechanical comparison of trigen retrograde intramedullary (im) nail, dynamic condylar screw (DCS), and locking compression plate (LCP) condylar plate. J Trauma 66(2):443–449. https://doi.org/10.1097/TA.0b013e31815edeb8 CrossRefPubMed

Wähnert D, Hoffmeier KL, von Oldenburg G et al (2010) Internal fixation of type-C distal femoral fractures in osteoporotic bone. J Bone Joint Surg Am 92(6):1442–1452. https://doi.org/10.2106/JBJS.H.01722 CrossRefPubMed

Mückley T, Wähnert D, Hoffmeier KL et al (2011) Internal fixation of type-C distal femoral fractures in osteoporotic bone. J Bone Joint Surg Am 93(Suppl 1):40-53. https://doi.org/10.2106/JBJS.J.01142

10.

Ricci WM, Bellabarba C, Evanoff B et al (2001) Retrograde versus antegrade nailing of femoral shaft fractures. J Orthop Trauma 15(3):161–169CrossRefPubMed

11.

Fantry AJ, Elia G, Vopat BG et al (2015) Distal femoral complications following antegrade intramedullary nail placement. Orthop Rev (Pavia) 7(1):5820–5820. https://doi.org/10.4081/or.2015.5820 CrossRef

12.

Kim PH, Leopold SS (2012) In brief: Gustilo-Anderson classification. Clin Orthop Relat Res 470(12):3624. https://doi.org/10.1007/s11999-012-2376-6 CrossRefPubMedCentral

13.

Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium-2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21(10 Supplement):S1–S133CrossRefPubMed

14.

Tsukada S, Wakui M (2017) Is overcorrection preferable for repair of degenerated articular cartilage after open-wedge high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc 25(3):785–792. https://doi.org/10.1007/s00167-015-3655-Z CrossRefPubMed

15.

Vandenbussche E, LeBaron M, Ehlinger M et al (2014) Blade-plate fixation for distal femoral fractures: a case-control study. Orthop Traumatol Surg Res 100(5):555–560. https://doi.org/10.1016/j.otsr.2014.06.006 CrossRefPubMed

16.

Kregor PJ, Stannard JA, Zlowodzki M et al (2004) Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures. J Orthop Trauma 18(8):509–520CrossRefPubMed

17.

Haidukewych G, Sems SA, Huebner D et al (2007) Results of polyaxial locked-plate fixation of periarticular fractures of the knee. J Bone Joint Surg Am 89(3):614–620. https://doi.org/10.2106/JBJS.G.01086 CrossRefPubMed

18.

Ricci WM, Streubel PN, Morshed S et al (2014) Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma 28(2):83–89. https://doi.org/10.1097/BOT.0b013e31829e6dd0 CrossRefPubMed

19.

Wu CC (2011) Retrograde dynamic locked nailing for aseptic nonunion of femoral supracondyle after antegrade locked nailing. Arch Orthop Trauma Surg 131(4):513–517. https://doi.org/10.1007/s00402-010-1183-3 CrossRefPubMed

20.

Epari DR, Kassi JP, Schell H et al (2007) Timely fracture-healing requires optimization of axial fixation stability. J Bone Joint Surg Am 89(7):1575–1585. https://doi.org/10.2106/JBJS.F.00247 PubMed

21.

Kulkarni SG, Varshneya A, Kulkarni GS et al (2012) Antegrade interlocking nailing for distal femoral fractures. J Orthop Surg (Hong Kong) 20(1):48–54. https://doi.org/10.1177/230949901202000110 CrossRef

22.

Tornetta P 3rd, Tiburzi D (2000) Antegrade or retrograde reamed femoral nailing. A prospective, randomised trial. J Bone Joint Surg Br 82(5):652–654CrossRefPubMed

23.

Salem KH, Maier D, Keppler P et al (2006) Limb malalignment and functional outcome after antegrade versus retrograde intramedullary nailing in distal femoral fractures. J Trauma 61(2):375–381. https://doi.org/10.1097/01.ta.0000230282.65606.81 CrossRefPubMed

24.

El-Kawy S, Ansara S, Moftah A (2007) Retrograde femoral nailing in elderly patients with supracondylar fracture femur; is it the answer for a clinical problem? Int Orthop 31(1):83–86. https://doi.org/10.1007/s00264-006-0137-4 CrossRefPubMed

25.

Halvorson JJ, Barnett M, Jackson B et al (2012) Risk of septic knee following retrograde intramedullary nailing of open and closed femur fractures. J Orthop Surg Res 7(1):1–4. https://doi.org/10.1186/1749-799X-7-7 CrossRef

26.

Clement H, Heidari N, Kosuge D et al (2011) Anatomical structures at risk with the proud retrograde femoral nail. Arch Orthop Trauma Surg 131(11):1539–1544. https://doi.org/10.1007/s00402-011-1347-9 CrossRefPubMed

27.

Kaspar K, Schell H, Seebeck P et al (2005) Angle stable locking reduces interfragmentary movements and promotes healing after unreamed nailing. J Bone Joint Surg Am 87(9):2028–2037. https://doi.org/10.2106/JBJS.D.02268 CrossRefPubMed

28.

Doht S, Lehnert T, Frey S et al (2012) Effective combination of bone substitute and screws in the jail technique: a biomechanical study of tibial depression fractures. Int Orthop 36(10):2121–2125. https://doi.org/10.1007/s00264-012-1604-8 CrossRefPubMedPubMedCentral

29.

Weimann A, Heinkele T, Herbort M et al (2013) Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study. BMC Musculoskelet Disord 14(1):120. https://doi.org/10.1186/1471-2474-14-120 CrossRefPubMedPubMedCentral

30.

Seifert J, Stengel D, Matthes G et al (2003) Retrograde fixation of distal femoral fractures: results using a new nail system. J Orthop Trauma 17(7):488–495CrossRefPubMed

31.

Iannacone WM, Bennett FS, DeLong WG Jr et al (1994) Initial experience with the treatment of supracondylar femoral fractures using the supracondylar intramedullary nail: a preliminary report. J Orthop Trauma 8(4):322–327CrossRefPubMed

32.

Huang SC, Lin CC, Lin J (2009) Increasing nail-cortical contact to increase fixation stability and decrease implant strain in antegrade locked nailing of distal femoral fractures: a biomechanical study. J Trauma 66(2):436–442. https://doi.org/10.1097/TA.0b013e318154013b CrossRefPubMed

33.

Larsen LB, Madsen JE, Høiness PR (2004) Should insertion of intramedullary nails for tibial fractures be with or without reaming?: a prospective, randomized study with 3.8 years’ follow-up. J Orthop Trauma 18(3):144–149CrossRefPubMed

34.

Papakostidis C, Psyllakis I, Vardakas D et al (2011) Femoral-shaft fractures and nonunions treated with intramedullary nails: the role of dynamisation. Injury 42(11):1353–1361. https://doi.org/10.1016/j.injury.2011.06.024 CrossRefPubMed

Title: The antegrade angle-stable locking intramedullary nail for type-C distal femoral fractures: a thirty four case experience
Authors: Zhihui Zhao
Yi Li
Kifayat Ullah
Basanta Sapkota
Hongbin Bi
Yongqing Wang
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 3/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3747-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The antegrade angle-stable locking intramedullary nail for type-C distal femoral fractures: a thirty four case experience

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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