Antegrade versus retrograde reamed interlocking femoral nailing. A comperative prospective study at Muhimbili Orthopaedic Institute(MOI)

Abstract

Background: Locked intramedullary nailing or interlocking nailing (ILN) is a proven mode of treatment for femoral shaft fractures in our hospital. It can be inserted via the ante grade or retrograde approach. Retrograde approach is technically less demanding especially if the patient is overweight. But there are concerns with regard to the violation of the knee and its effect on subsequent knee function.

Methods: 80 cases of femoral shaft fractures treated with locked intramedullary Nailing (SIGN NAILS) at the Muhimbili Orthopaedic Institute (MOl), March to December 2009 were enrolled in this study; 63 were males and 17 were females with a male to female ratio of 3.7:1.

I looked at radiological and clinical fracture union rates, alignment of the operated limb, knee function using the Thoresen scoring system, Implant failure rate, wound infection rate.

Results: There were a total of 80 cases of femoral interlocking nails during the study period. Forty-two cases were ante grade nails and 38 cases were retrograde nails. 77(96.25%) patients achieved union,3 patients had non union(both were hypertrophic).

There was no significant difference between both groups, in regards to average time of fracture union, knee pain or swelling, extension deficit, and range of motion as well as post nailing femoral alignment(p>0.05),wound infection and implant failure rate.

vu However patients treated through antegrade femoral nail fixation had better knee flexion compared to those ofthe retrograde with a p value >0.05 Conclusions: Both methods of nailing achieved excellent union rates with good alignment of the limb. Contrary to popular belief, It was found that retrograde nailing does not give rise to a higher rate of knee complications. Therefore, retrograde femoral nailing approach is strongly recommended.