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Locked intramedullary nailing of diaphyseal femur fractures without intraoperative fluoroscopy, fracture table and power reaming: retrograde affords greater procedural efficiency than antegrade approach

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Abstract

Purpose

To compare the intraoperative procedural efficiency of antegrade and retrograde locked intramedullary nailing of diaphyseal femur fractures without intraoperative fluoroscopy, power reaming devices and fracture tables.

Methods

A secondary analysis of prospectively collected data was conducted on 238 isolated diaphyseal femur fractures fixed with SIGN Standard and Fin nails within three weeks of injury. The data included baseline patient and fracture characteristics, nail type and diameter, fracture reduction methods, operative times and outcome measures.

Results

There were 84 and 154 fractures in the antegrade and retrograde groups respectively. Both groups were similar vis-a-vis baseline patient and fracture characteristics. Closed reduction of the fractures was significantly easier for retrograde than an antegrade approach. The retrograde approach more readily permitted the use of Fin nails. The mean nail diameter used for retrograde was significantly larger than that for antegrade. The time taken to achieve retrograde nailing was significantly lesser than that of antegrade. There was no statistically significant difference between the outcomes of the two groups.

Conclusion

In the absence of expensive fracture-surgery gadgets, retrograde nailing offers many procedural advantages over antegrade, such as easier closed reduction and canal reaming, the greater possibility of using the Fin nail with fewer interlocking screws and shorter operative times. However, we acknowledge the lack of randomisation and the presence of an unequal number of fractures in the two groups as limitations of this study.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors are deeply grateful to SIGN Fracture Care International and its founder and president, Lewis G. Zirkle, for the free donation of SIGN implants and training without which this study would not have been possible

Author information

Authors and Affiliations

  1. Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria

    Stephen Adesope Adesina, Isaac Olusayo Amole, Oluwafemi Oyewole Oyewusi, Imri Goodness Adefokun, David Opeyemi Adeniji, Adepeju Olatayo Adegoke, Simeon Ayorinde Ojo, James Idowu Owolabi & Samuel Uwale Eyesan

  2. Bowen University, P.M.B 284, Iwo, Osun State, Nigeria

    Stephen Adesope Adesina, Isaac Olusayo Amole, Adepeju Olatayo Adegoke, Simeon Ayorinde Ojo, James Idowu Owolabi & Samuel Uwale Eyesan

  3. National Orthopaedic Hospital, Igbobi, Lagos, Nigeria

    Ehimen Oluwadamilare Odekhiran

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  1. Stephen Adesope Adesina
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Adesina Stephen Adesope, Amole Isaac Olusayo, Oyewusi Oluwafemi Oyewole, Adefokun Imri Goodness, Odekhiran Ehimen Oluwadamilare and Adeniji David Opeyemi. The first draft of the manuscript was written by Adesina Stephen Adesope, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Stephen Adesope Adesina.

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Ethics approval

The study was approved by the Institutional Review Board of Bowen University Teaching Hospital, Ogbomoso, Oyo State Nigeria.

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for the publication of the images in Fig. 3, 4 and 5.

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Adesina, S.A., Amole, I.O., Oyewusi, O.O. et al. Locked intramedullary nailing of diaphyseal femur fractures without intraoperative fluoroscopy, fracture table and power reaming: retrograde affords greater procedural efficiency than antegrade approach. International Orthopaedics (SICOT) 47, 1845–1853 (2023). https://doi.org/10.1007/s00264-023-05832-8

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