Abstract
Background
Supracondylar fractures of femur constitute 7% of all femoral fractures. In elderly patients, they are invariably low-energy fractures predisposed to by osteoporosis. Treatment of these fractures in the elderly is a challenging task for most orthopaedic surgeons. There is no consensus on what would be the ideal treatment for such cases. This study looks at the results of retrograde femoral nailing as a treatment option for this vulnerable group of patients.
Patients and methods
This retrospective study looks at 23 elderly patients with supracondylar fractures of the femur treated by retrograde femoral nailing. Patients had an average age of 75 years (range between 65 years and 97 years). All patients were assessed with regard to operative time, blood loss, hospital stay, and postoperative complications. All patients were assessed clinically and radiologically every 6 weeks for average period of 14 months (range 12 to 18 months).
Results
two patients died a few weeks postoperatively. Average operative time 70 minutes, average blood loss 350ml. Radiologically all cases united, 39.2% had angular malalignment. There were no cases of implant or fixation failure.
Conclusion
Retrograde femoral nailing is a surgically limited and reliable procedure for elderly patients with supracondylar fractures of the femur without intra-articular extension. Although it has a high incidence of angular malalignment, the overall functional demands of this age group are perhaps not affected much by that particular complication.
Résumé
Background
Les fractures supra condyliennes du fémur constituent 7% de toutes les fractures fémorales. Chez les patients âgés l’ostéoporose prédispose à ce type de fractures. Le traitement de ces fractures chez les patients âgés est difficile. Il n’y a pas de consensus sur le traitement idéal. Le but de cette étude est d’étudier les résultats sur l’enclouage fémoral rétrograde.
Patients et méthode
les résultats d’une étude rétrospective de 23 patients présentant une fracture supra condylienne du col fémoral traitée par enclouage fémoral rétrograde ont été évalués. Les patients avaient un âge moyen de 75 ans (de 65 à 97) à l’intervention. Tous les patients ont été évalués en termes de temps opératoire, de perte sanguine, de durée moyenne de séjour et de complications postopératoires. Tous les patients ont été évalués cliniquement et radiologiquement toutes les 6 semaines sur une période de 14 mois (12 à 18 mois).
Résultats
2 patients sont décédés deux semaines après l’intervention. La durée moyenne opératoire a été de 70 minutes, les pertes sanguines moyennes de 350 ml. Radiologiquement tous les cas ont consolidé mais 39,2% avaient un cal vicieux. Il y n’y avait qu’un cas de faillite de l’implant.
En conclusion
l’enclouage fémoral rétrograde est une technique sûre chez les patients âgés, présentant une fracture supra condylienne du fémur. Cependant il existe une fréquence relativement importante du cal vicieux mais la demande fonctionnelle des patients de cet âge n’entraîne pas de handicap particulier.
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El-Kawy, S., Ansara, S., Moftah, A. et al. Retrograde femoral nailing in elderly patients with supracondylar fracture femur; is it the answer for a clinical problem?. International Orthopaedics (SICO 31, 83–86 (2007). https://doi.org/10.1007/s00264-006-0137-4
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DOI: https://doi.org/10.1007/s00264-006-0137-4