Abstract
In adults, supracondylar fractures of the femur occur in two age groups, young subjects victims of high-energy trauma often with associated injuries, and old subjects, generally women, victims of low-energy trauma with no other injury.
The basic problem is the difficult reduction and stabilization. Once this has been achieved, the objective is to avoid knee stiffness, nonunion, and a misaligned callus.
The goal of treatment is to restore anatomic configuration, achieve stable fixation, and allow early mobilization.
Based on work by Seligsson and Lannacone in 1993–1994, we began treating these fractures with retrograde centromedullary nailing. Our first report of 17 cases was published in 1999. We have analyzed 42 cases with mean three year four months follow-up: 40 healed at 74 days on average, with only two cases of nonunion. Knee flexion was greater than 80° in 36 patients and there were no deformed calluses. The positioning technique is easy, biological, and totally safe. There are few complications and outcome is good.
Retrograde nailing is indicated for closed or open Gustilo I-II fractures, group A and C1-2 fractures in the AO classification.
Contraindications are open Gustilo III fractures and AO C3 fractures, or fractures with a very low supracondylar localization.
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