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Medial femoral condyle fracture as a complication of antegrade intramedullary nailing

  • Trauma Surgery
  • Published:
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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.

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References

  1. Ricci WM, Gallagher B, Haidukewych GJ (2009) Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg 17:296–305

    PubMed  Google Scholar 

  2. 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

    Google Scholar 

  3. 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

    CAS  Google Scholar 

  4. Godstiff SP, Heywood-Waddington MB (1993) Closed intramedullary nailing complicated by breakage of plastic medullary tube. Injury 24(2):136–137

    Article  Google Scholar 

  5. 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

    Article  PubMed  CAS  Google Scholar 

  6. Christie J, Court-Brown C (1988) Femoral neck fracture during closed intramedullary nailing. J Bone Joint Surg [Br] 708:670

    Google Scholar 

  7. 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

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  10. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  11. Vécsei V, Heinz T (1990) The interlocking nail for long comminuted and compound fractures of the femur and tibia. Unfallchirurg 93:512–518

    PubMed  Google Scholar 

  12. 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

    Article  PubMed  CAS  Google Scholar 

  13. 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

    Article  PubMed  CAS  Google Scholar 

  14. 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

    Article  PubMed  CAS  Google Scholar 

  15. Marks PH, Paley D, Kellam JF (1988) Heterotopic ossification around the hip with intramedullary nailing of the femur. J Trauma 28:1207–1213

    Article  PubMed  CAS  Google Scholar 

  16. 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

    Article  Google Scholar 

  17. Khan FA, Ikram MA, Badr AA, Al-Khawashki H (1995) Femoral neck fracture: a complication of femoral nailing. Injury 26(5):319–321

    Article  PubMed  CAS  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. 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

    Google Scholar 

  20. 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

    Google Scholar 

  21. 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

  22. 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

    Article  PubMed  Google Scholar 

  23. 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

  24. Wolinski PR, McCarty E, Shyr Y, Johnson K (1999) Reamed intramedullary nailing of the femur: 551 cases. J Trauma 46:392–399

    Article  Google Scholar 

  25. 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

    Article  Google Scholar 

  26. 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

  27. 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

    Google Scholar 

  28. 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

    Google Scholar 

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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.

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Correspondence to F. Neumayer.

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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

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  • DOI: https://doi.org/10.1007/s00402-013-1796-4

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