Abstract
In this retrospective radiographic review, we compared the adequacy of reduction of 18 femoral fractures treated by retrograde and 35 fractures treated by pro-grade nailing.
The groups were similar with regard to age, gender and side of the fracture. In the prograde group, there were eight fractures of type A5, 25 of type A3 and two of type C2. In the retrograde group there were two type-A2 fractures, 14 type-A3 and two type-C2. On the Winquist classification there were eight group-0, two group-1, two group-3 and 23 group-4 fractures in the prograde group, and two group-0, one group-3 and 15 group-4 fractures in the retrograde group.
We measured the lateral femoral angle (LFA) from the anatomical axis to assess alignment postoperatively. We considered an LFA value of 83( normal and LFA values between 78( and 88( acceptable. The LFA was greater than 88( in 3% of the prograde group and in 6% of the retrograde group. In the prograde and retrograde groups, 86% and 83% of the nails respectively were in the acceptable range. In both groups, the LFA was less than 78( in 11%. There was shift of more than 1 cm in 17% of the prograde and in 44% of the retrograde groups. Recurvatum of more than 5( was seen in 31%( of prograde and 22% of retrograde nailings. In the retrograde group, 67% of nails were distal to the femoral notch on the lateral radiograph and were deemed to be proud.
We concluded that prograde and retrograde nailing of distal third femur fractures gave comparable results in terms of alignment, but that recurvatum could be problematic with prograde nailing and that shift and proud nails were a concern with retrograde nailing. The clinical significance of these results has still to be determined.
The abstracts were edited by Prof. M.B.E. Sweet. Correspondence should be addressed to him at the Department of Orthopaedic Surgery, Medical School, University of the Witwatersrand, 7 York Road, Parktown, 2193 South Africa
