Abstract
A 49-year-old man suffered a closed oblique fracture of the middle third of his left femur. Closed reduction and internal fixation by intramedullary (IM) nailing were performed. Per-operative fluoroscopic imaging and initial postoperative X-rays were judged normal and the patient followed the usual rehabilitation protocol. At 3-month follow-up the patient still demonstrated poor knee function and pain. A plain X-ray and a CT scan of the left knee revealed a displaced fracture of the medial femoral condyle. Analysis of the postoperative imaging suggests that the fracture occurred during the insertion of the IM nail. The nail possibly hit the Steinmann traction pin in the distal femur causing the medial condyle fracture. The patient was reoperated; open reduction and internal plate and screw fixation were performed with satisfactory clinical progress postoperatively. The description and illustration of this case is intended to make trauma surgeons aware of this rare but serious complication of IM femoral nailing.
References
Ricci WM, Gallagher B, Haidukewych GJ (2009) Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg 17:296–305
Winquist RA, Hansen ST Jr, Clawson DK (1984) Closed intramedullary nailing of femoral fractures: a report of five hundred and twenty cases. J Bone Joint Surg [Am] 66-A:529–539
Kempf I, Grosse A, Beck G (1985) Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg [Am] 67(5):709–720
Godstiff SP, Heywood-Waddington MB (1993) Closed intramedullary nailing complicated by breakage of plastic medullary tube. Injury 24(2):136–137
Ip D, Wu WC, Wong SH (2001) Rare complication of segmental breakage of plastic medullary tube in closed intramedullary nailing. Injury 32(9):730–731
Christie J, Court-Brown C (1988) Femoral neck fracture during closed intramedullary nailing. J Bone Joint Surg [Br] 708:670
Grimme K, Gosling T, Pape HC, Schandelmaier P, Krettek C (2004) Fraktur des medialen Femurkondylus als Komplikation bei der Entfernung eines retrograden Femurnagel. Unfallchirurg 107:532–535
Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ (2006) The international knee documentation committee subjective knee evaluation form: normative data. Am J Sports Med 34:128–135
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
Vécsei V, Heinz T (1990) The interlocking nail for long comminuted and compound fractures of the femur and tibia. Unfallchirurg 93:512–518
Jaarsma RL, Pakvis DF, Verdonschot N, Biert J, van Kampen A (2004) Rotational malalignment after intramedullary nailing of femoral fractures. J Orthop Trauma 18(7):403–409
Bhandari M, Guyatt GH, Tong D, Adili A, Shaughnessy SG (2000) Reamed versus nonreamed intramedullary nailing of lower extremity long bone fractures: a systematic overview and meta-analysis. J Orthop Trauma 14:2–9
Pape HC, Dwenger A, Regel G, Schweitzer G, Jonas M, Remmers D et al (1992) Pulmonary damage after intramedullary femoral nailing in traumatized sheep: Is there an effect from different nailing methods? J Trauma 33:574–581
Marks PH, Paley D, Kellam JF (1988) Heterotopic ossification around the hip with intramedullary nailing of the femur. J Trauma 28:1207–1213
Tornetta P 3rd, Kain MS, Creevy WR (2007) Diagnosis of femoral neck fractures in patients with a femoral shaft fracture. Improvement with a standard protocol. J Bone Joint Surg [Am] 89:39–43
Khan FA, Ikram MA, Badr AA, Al-Khawashki H (1995) Femoral neck fracture: a complication of femoral nailing. Injury 26(5):319–321
Grala P, Mańkowski B, Kierzynka G (2009) Femoral neck fracture following intramedullary nailing with misplacement of an end cup: report of two cases. J Orthop Traumatol 10(1):35–38
Probe RA (2006) Anterograde femoral nailing without a fracture table. In: Leung K-S, Taglang G, Seidel H, Kempf I et al (eds) Practice of intramedullary locked nails: new developments in techniques and applications. Birkhäuser, Philadelphia
Nork SE (2009) Femoral shaft fractures. In: Buchholz RW et al (eds) Rockwood and Green’s fractures in adults, 7th edn. Lippincott Williams & Wilkins, USA, pp 1656–1719
Giannoudis PV, Pape HC, Schütz M (2011) Femur shaft 32-A2 CRIF midshaft—reduction and fixation. In: Colton C, Schatzker J, Trafton P (eds) AO Surgery Reference. https://www2.aofoundation.org/wps/portal/!ut/p/c1/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3Q1dDA08XN59Qz8AAQwMDA6B8JJK8haGFgYFnqKezn7GTH1DahIBuP4_83FT9gtyIcgBttnJy/dl2/d1/L2dJQSEvUUt3QS9ZQnB3LzZfQzBWUUFCMUEwRzFFMTBJREZMVUlRUDEwMDA!/?showPage=redfix&bone=Femur&segment=Shaft&classification=32-A2&treatment=&method=CRIF(closedreductioninternalfixation)&implantstype=Antegradenailing(midshaft/distalshaft)&approach=&redfix_url=1285238479318
Kwon JY, Johnson CE, Appleton P, Rodriguez EK (2010) Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures. J Orthop Surg Res 5:4
Taglang G, Schenck B, Averous C (1998) The gamma nails (standard, trochanteric, and long) tips and pitfalls Maîtrise Orthopédique n° 75. http://www.maitrise-orthop.com/viewPage_us.do?id=392
Wolinski PR, McCarty E, Shyr Y, Johnson K (1999) Reamed intramedullary nailing of the femur: 551 cases. J Trauma 46:392–399
Wolinski PR, McCarty E, Shyr Y, Johnson K (1998) Length of operative procedures: reamed femoral intramedullary nailing performed with and without a fracture table. J Orthop Trauma 12:485–495
Kempf I, Pidhorz L (2000) Enclouage des fractures de la diaphyse fémorale. Encycl Méd Chir Techniques chirurgicales, Orthopédie-Traumatologie, Editions Scientifiques et Médicales Elsevier SAS, Paris, pp. 44–705, 6p
Höntzsch D (2000) Femur shaft (incl. subtrochanteric). In: Rüedi TP, Murphy WM (eds) AO principles of fracture management. Davos, AO Publishing: Thieme, New York, pp 457–468
Court-Brown CM (2003) Femoral diaphyseal fractures. In: Browner BD et al (eds) Skeletal trauma—basic science, management, and reconstruction, 3rd edn. Saunders, Philadelphia, pp 1879–1956
Conflict of interest
On behalf of all the authors, we disclose any financial and personal relationships with other people, or organisations, that could inappropriately influence (bias) our work. There are no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Neumayer, F., Löcherbach, C., McManus, J. et al. Medial femoral condyle fracture as a complication of antegrade intramedullary nailing. Arch Orthop Trauma Surg 133, 1273–1279 (2013). https://doi.org/10.1007/s00402-013-1796-4
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-013-1796-4