The Journal of Bone and Joint Surgery, Vol 73, Issue 10 1492-1502, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Interlocking intramedullary nailing for ipsilateral fractures of the femoral shaft and distal part of the femur
MS Butler, RJ Brumback, TS Ellison, A Poka, GH Bathon and AR Burgess
Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems, Baltimore 21201-1595.
A review of the data on 684 fractures of the femur that had been treated
with intramedullary nailing led to the identification of twenty-three
patients who had had a fracture of the shaft of the femur with an
accompanying ipsilateral supracondylar fracture (twelve patients, group I)
or a concomitant ipsilateral intercondylar fracture (eleven patients, group
II). The group-I fractures had been treated with interlocking nailing
without supplemental fixation. In group II, ten fractures were stabilized
with interlocking nailing and supplemental screw fixation and one, with
interlocking nailing and a supplemental plate and screws. The average time
to union for all fractures was nineteen weeks (range, twelve to thirty-six
weeks), and the average duration of clinical and radiographic follow-up was
thirty months (range, nine to fifty-nine months). In group I, alignment of
the femur was within 5 degrees of normal in ten of the twelve fractures. In
group II, seven intra-articular fractures healed in anatomical alignment,
three had slight articular displacement (1.0 to 3.0 millimeters), and one
had displacement of more than 3.0 millimeters. The average range of motion
of the knee at the most recent follow-up was 0 to 120 degrees in group I
and 0 to 115 degrees in group II. Two patients (both in group II) needed a
reoperation for a previously unrecognized fracture of a femoral condyle in
the coronal plane; post-traumatic arthritis developed in both. No patient
in either group had loss of fixation or failure of the implant. We
concluded that ipsilateral diaphyseal, supracondylar, and intercondylar
fractures of the femur can be adequately stabilized with interlocking
nailing and supplemental intercondylar screw fixation. The presence of a
fracture in the coronal plane of a femoral condyle (AO type-B3 and type-C3
injuries) is a relative contraindication to the use of this technique.
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