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Retrograde Versus Antegrade Intramedullary Nailing of Gunshot Diaphyseal Femur Fractures

  • Symposium: Civilian Gunshot Injuries
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The use of retrograde nailing for gunshot wound femur fractures is controversial due to concerns of knee sepsis after this procedure since the knee is entered to introduce the nail into the canal.

Questions/purposes

We compared retrograde and antegrade nailing for gunshot femur fractures to determine whether (1) knee sepsis or other adverse events were more likely to complicate procedures using retrograde nails, (2) there were differences in surgical time or blood loss, and (3) there were differences in radiographic union.

Methods

We retrospectively reviewed our prospective trauma database from 1999 to 2012 for patients with a diagnosis of gunshot and femur fracture. We performed a detailed review of medical records and radiographs for those patients with OTA Classification Type 32 femur fractures secondary to gunshot injury treated with either retrograde or antegrade femoral nailing. Eighty-one patients were treated with intramedullary nailing (53 retrograde and 28 antegrade). We reviewed elements of the operative treatment (procedure, anesthesia time, operative time, and estimated blood loss) for all 81 patients. For clinical and radiographic review, followup was adequate for 43 and 25 patients with retrograde and antegrade nailing, respectively. Minimum followup was 3 months for both groups (retrograde: mean, 41 months; range, 3–148 months; antegrade: 26 months: range, 3–112 months).

Results

No patients in either group developed knee sepsis. No significant differences were found between groups with regard to operative time, blood loss, or radiographic union.

Conclusions

With the numbers available, immediate retrograde nailing appears as safe and effective as antegrade nailing for gunshot femur fractures. Immediate retrograde nailing is as safe as antegrade nailing for gunshot femur fractures.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Detroit Receiving Hospital, 4201 St Antoine Street, Detroit, MI, 48201, USA

    Paul J. Dougherty MD, Petra Gherebeh MD, Mark Zekaj BS, Sajiv Sethi BS, Bryant Oliphant MD & Rahul Vaidya MD

Authors
  1. Paul J. Dougherty MD
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  2. Petra Gherebeh MD
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  3. Mark Zekaj BS
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  4. Sajiv Sethi BS
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  5. Bryant Oliphant MD
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  6. Rahul Vaidya MD
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Corresponding author

Correspondence to Paul J. Dougherty MD.

Additional information

The institution of the authors has received, during the study, funding from Synthes (Paoli, PA, USA). One of the authors (RV) certifies that he or she, or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from AO Trauma (Paoli, PA, USA) and Stryker Corp (Kalamazoo, MI, USA). Each remaining author (PD, PG, MZ, SS, BO) certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Cite this article

Dougherty, P.J., Gherebeh, P., Zekaj, M. et al. Retrograde Versus Antegrade Intramedullary Nailing of Gunshot Diaphyseal Femur Fractures. Clin Orthop Relat Res 471, 3974–3980 (2013). https://doi.org/10.1007/s11999-013-3058-8

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  • DOI: https://doi.org/10.1007/s11999-013-3058-8

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