Retrograde nailing has been effective in patients with multiple system injuries or multiple fractures. This technique is performed on a radiolucent operating table to ensure full fluoroscopic visualization. For axially stable injuries, manual traction is sufficient to reduce the fracture and to allow nailing. Fractures with extensive comminution and axial instability often require application of a femoral distractor. Insertion can be accomplished through a small midline patellar ligament splitting approach. A cannulated entry portal reamer facilitates the correct nail entry hole. Proximal interlocking is undertaken using a simple freehand technique. Using a design-specific femoral nail for retrograde insertion, which incorporates the concepts of canal fill and early dynamization, our rate of union for this technique approaches 94% with time to union of approximately 12.6 weeks. No symptoms of knee pain or dysfunction have been attributed to the nail insertion site. This technique is not advocated for replacement of antegrade techniques, but can be an additional tool used to facilitate the care of certain patients by allowing shorter operating room time setup, decreased blood loss, and avoidance of the use of the fracture table.
Address correspondence and reprint requests to J. Tracy Watson, MD, Division of Orthopaedic Traumatology, Department of Orthopaedic Surgery, Henry Ford Hospital, (K-12) 2799 West Grand Blvd., Detroit, MI 48202, U.S.A.
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