Retrograde reamed femoral nailing.

Closed, reamed, antegrade nailing remains the standard of care for femoral shaft fractures. This technique however, may be less attractive in the management of femoral shaft fractures associated with (a) ipsilateral acetabular, pelvis, or femoral neck fractures; (b) poly trauma requiring multiple simultaneous surgical procedures; and (c) pregnancy. We now report on our experience with the retrograde femoral nailing as a treatment option in these situations. Between 4/88 and 10/90, 29 retrograde femoral nailing in 24 patients were attempted. Average age was 29.3 (16-74) years. Five fractures were open. Fracture location was isthmal in 14 and infraisthmal in 15. The comminution was classified according to Winquist and Hansen: I(10), II(7), III(7), and IV(5). Nailing was possible in 28/29 cases. Insertion was made through an extraarticular medial condylar portal. Nail diameter ranged from 10 to 13 mm. An AO Universal Femoral Nail was used in the first 11 cases; all subsequent fractures were stabilized using an AO Universal Tibial Nail because its design appeared better suited to this technique. Follow-up was possible for 25 fractures in 21 patients and averaged 16.0 (range, 11-27); months 23/25 (92%) fractures healed within 12 weeks. No case was associated with an infection, loss of reduction, or nail failure. Knee flexion averaged 122°; only two knees had an extensor lag of >5°. Intraoperative complications included three cases of crack propagation at the insertion site, and four infraisthmal malreductions (two valgus, two flexion). Based on these results, we feel that retrograde reamed femoral nailing is a suitable alternative to antegrade nailing and should be considered in situations where proximal access is neither possible nor desirable.

Retrograde reamed femoral nailing.

Closed, reamed, antegrade nailing remains the standard of care for femoral shaft fractures. This technique however, may be less attractive in the management of femoral shaft fractures associated with (a) ipsilateral acetabular, pelvis, or femoral neck fractures; (b) polytrauma requiring multiple simultaneous surgical procedures; and (c) pregnancy. We now report on our experience with the retrograde femoral nailing as a treatment option in these situations. Between 4/88 and 10/90, 29 retrograde femoral nailing in 24 patients were attempted. Average age was 29.3 (16-74) years. Five fractures were open. Fracture location was isthmal in 14 and infraisthmal in 15. The comminution was classified according to Winquist and Hansen: I(10), II(7), III(7), and IV(5). Nailing was possible in 28/29 cases. Insertion was made through an extraarticular medial condylar portal. Nail diameter ranged from 10 to 13 mm. An AO Universal Femoral Nail was used in the first 11 cases; all subsequent fractures were stabilized using an AO Universal Tibial Nail because its design appeared better suited to this technique. Follow-up was possible for 25 fractures in 21 patients and averaged 16.0 (range, 11-27); months 23/25 (92%) fractures healed within 12 weeks. No case was associated with an infection, loss of reduction, or nail failure. Knee flexion averaged 122 degrees; only two knees had an extensor lag of > 5 degrees. Intraoperative complications included three cases of crack propagation at the insertion site, and four infraisthmal malreductions (two valgus, two flexion). Based on these results, we feel that retrograde reamed femoral nailing is a suitable alternative to antegrade nailing and should be considered in situations where proximal access is neither possible nor desirable.

Fracture fixation with biodegradable rods. Forty-one cases of severe ankle fractures.

In a prospective study of 41 patients, severe ankle fractures of Lauge-Hansen types SE III-IV, PA III, and PE III-IV were treated by open reduction and internal fixation using biodegradable self-reinforced polyglycolide cylinder-shaped rods. Disruption of the distal tibiofibular syndesmosis and/or fracture of the posterior tibial margin requiring reduction and fixation were the inclusion criteria for the study. The mean follow-up time after operation was 16 (12-32) months. Two failures of fixation necessitated reoperation. A secondary displacement of 1-2 mm of the lateral malleolus occurred in 3 cases. Transient accumulation of soluble polyglycolide mass complicated the course in 3 cases, but did not influence the radiographic or the functional result. Function became good in 30 patients. The advantage of the biodegradable implants is that they do not need to be removed at secondary operations.

[The incidence, therapy and results of combined ankle joint and tibial shaft fractures]. / Inzidenz, Therapie und Ergebnisse von kombinierten Sprunggelenks- und Schienbeinschaftbrüchen.

Forty combined tibial shaft and ankle fractures were admitted to our Trauma Department between 1980 and 1985; these cases were followed up, and the results are presented. Using the classification scheme of Johner/Wruhs for lower-leg fractures and that of Lauge-Hansen for ankle fractures, we found 25 pronation-eversion and 14 supination-eversion lesions combined with pure spiral fractures (A1, 9 cases), spiral bending-type fractures (B1, 25 cases), comminuted spiral lesions (C1, 5 cases), and 1 crush fracture (C3). Although no fibular or ligamentous reconstruction had been done and various methods had been used, overall, the late results were good. In contrast to previous reports about this rare condition, no incongruencies at the ankle joint were found. Only 2 cases of late arthritis due to infection and/or improper reduction were seen. Nevertheless, the importance of thorough analysis of the fracture pathomechanics before treatment cannot be overemphasized. If anatomical reduction of the tibial shaft fracture does not imply congruency at the joint line, reconstruction of the fibular or ligamentous lesion should be undertaken.