Mid- to Long-Term Clinical Findings in Nailing of Distal Femoral Fractures

The purpose of the study was to evaluate clinical long-term results after nailing of distal femoral fractures. The first 22 consecutive cases of distal femoral fractures in 22 patients (2 males and 20 females, age 65 years, range, 16–97 years) treated with retrograde femoral nailing from October 1994 to May 1997 are reported. Indications were AO 33 A1 (n D 7), 33 A2 (n D 2), 33 A3 (n D 3), and 33 C2 (n D 7) fractures. In 11 cases these were periprosthetic fractures of either total hip arthroplasty or hemiarthroplasty of the hip (five) or dynamic hip screw (six), four patients were polytraumatized, one patient had a floating-knee injury. No infections or thrombosis were observed postoperatively. In 17 cases primary union was achieved within 11 weeks (8–17 weeks); five patients died before consolidation. Patients returned to full weightbearing after 5 weeks (4–12 weeks); active knee motion ranged from 80° to 130°. In five patients slight malalignment <10° was radiographically assessed, with two showing incipient degenerative joint disease. Patients younger than 60 years returned to full preoperative activity level. Eleven patients surviving an average of 5.2 years (4.3–6.9 years) were available for long-term follow-up. As a subgroup they were evaluated according to the Leung score for distal femoral fractures with seven excellent and four good results and an average score of 84.3 points (70–92 points). The mid- to long-term results confirm retrograde femoral nailing to be a good alternative to plate osteosynthesis for AO 33 A- and C2-type fractures. In young patients (<60 years) postoperative clinical performance was highly satisfying; however, the effects of postoperative hemarthros and anatomic malalignment on the cartilage surface remain major issues for further investigation. (Journal of Surgical Orthopaedic Advances 12(4):218–224, 2003