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The Journal of Bone and Joint Surgery 78:1092-5 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.

Intra-Articular Penetration of the Knee Joint by a Fragment of Cortical Bone during Intramedullary Nailing of the Femur. A Report of Two Cases*

DARREN L. JOHNSON, M.D.{dagger} and DONALD A. WISS, M.D.{ddagger}, LOS ANGELES, CALIFORNIA

Investigation performed at the Division of Hand Surgery, Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento


   Introduction
 
The preferred treatment for comminuted fractures of the femur extending from the lesser trochanter to the adductor tubercle is fixation with an intramedullary locking nail5-7,11,12,15,24-31. The reported intraoperative complications of nailing have included an eccentric entry portal, problems with reaming, binding of the nail, iatrogenic comminution of the fracture, distraction of the fragments, extrusion of the nail into the soft tissues, injury of the femoral or popliteal artery, traction palsy of the sciatic or pudendal nerve, and penetration of the knee joint by the nail1-4,7-9,11-13,16-23. We report the cases of two patients in whom a fragment of cortical bone became trapped in the open tip of an intramedullary nail and was driven into the knee joint during nailing of the femur.


   Case Reports
 
CASE 1. A forty-five-year-old man was in a motorcycle accident and sustained a grade-II open, comminuted, supracondylar fracture of the femur10 and that extended into the intercondylar . . . [Full Text of this Article]


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