Retrograde dynamic locked intramedullary nailing for distal femoral aseptic nonunion associated with broken antegrade locked nail

Abstract

Techniques for treating distal femoral aseptic nonunions associated with antegrade locked nail breakage are controversial. Each technique has unique advantages and disadvantages. Retrograde dynamic locked nailing was used in such treatment.

Twelve patients with the described disorders were treated with retrograde dynamic traditional femoral locked nails. The proximal segment of the broken nail was removed from the hip area with the patient in the lateral decubitus position. Consequently, the patient was changed to the supine position. The distal segment of the broken nail was removed from the intercondylar inlet and a dynamic locked nail was inserted in a retrograde fashion. Two staples were used for reinforcing rotational stability whenever necessary. Early ambulation with protected weight bearing was encouraged.

All 12 patients with 12 nonunions were followed for an average of 2.9 years (range, 1.1-4.7 years). All nonunions healed with a union rate of 100%, and the average time to union was 4.2 months (range, 3.0-5.5 months). There were no complications of nonunions, malunions or deep infection. Satisfactory knee function among 12 patients improved from 42% pre-operatively to 100% at the latest follow-up (p = 0.002). All 12 patients could walk without aids.

The described technique may be an excellent alternative for treating a distal femoral aseptic nonunion associated with antegrade locked nail breakage. The technique is not difficult and the union and satisfactory rates are high.