Communication orale
Traumatology
ABSTRACT N° SOFCOT24-1374
Retrograde nailing for distal femur fractures
about 100 cases
zied mansi 1, Abdelkader Tounsi* 1, ines sboui 2, aymen ben mahmoud 1, hedi rbai 1
1orthopedie , hopital ibn jazzar , kairouan , 2chirurgie de la main , institut kassab , tunis , Tunisia
Introduction : Retrograde centromedullary nailing of the femur represents a means of osteosynthesis widely used for fractures of the distal femur. Indeed, its advantages are essentially based on the reduction of the operating time and therefore the reduction of blood loss.
Material and methods : We report a descriptive and analytical retrospective study,
conducted in the orthopedic and traumatological surgery department ,
collecting 100 cases of retrograde nailing of the femur over a period of 10 years
from 1 January , 2011 at 31 December 2020.
Results : The average age of our patients was 56 years old with a female
preponderance. Road accidents were the most frequent etiology (65%). We
adopted for the anatomopathological study, the classification of the SOFCOT
1988 and the classification of the AO considering their simplicity and their
anatomo-therapeutic correlations, thus we noted 27% of cases of type I
fracture, 42% of type II, 11% type III, 14% type IV, 5% type V and 1% type VI,
likewise, 8% type 33-A1, 19% type 33 -A2, 53% type 33 -A3, 14% type 33-C1, 5%
type 33-C2 and 1% type 33-C3.
On the operative level, the average time for intervention was 5.1 days, spinal
anesthesia was performed in 76% of cases.
The transtendinous midline was used in 76% of cases. All nails were inserted
after proper reaming. The mean operative time was 85.4 min. The average
postoperative hospital stay was 3.6 days. All of our patients consolidated within
an average of 4 months. The functional results were good and very good in 90%
and very good in 78% on the anatomical level according to the analysis criteria
of Vidal and Marchand. We noted no death or throbo-embolic complication.
We noted 7 cases of pseudarthrosis (7%) and 12 cases of malunion (12%).
Discussion : The current standard treatment for distal femur fractures involves closed intramedullary nailing with reaming, often using locking techniques. This method offers advantages such as lower infection risk, better bone healing, and extended indications for different fracture types. However, complications related to the osteosynthesis material still occur.Researchers propose using long, solid titanium nails to address these issues, citing benefits like reduced fracture focus and better protection against iterative fractures. Additionally, retrograde femur nailing is advantageous in specific situations, including polytrauma and elderly patients.Overall, retrograde nailing presents a promising alternative with good consolidation rates and low complication rates, but precision is crucial, especially concerning the nail entry point. Despite concerns about knee cartilage disruption, infection risks are low, and knee mobility is minimally affected.
Conclusion :
Retrograde nailing is gaining popularity as a treatment for lower femur fractures in adults. It offers benefits similar to closed intramedullary osteosynthesis, with high consolidation rates and low complication rates. Precise technique and patient suitability are crucial. Despite minimal risks such as knee arthrotomy, infection rates are low, and knee mobility remains largely unaffected
Do you have any links of interest related to this presentation? : No
Has AI been used for this abstract beyond spell checking or translation? : No
Conflits d’intérêts : Pas de conflit déclaré