TOTBİD Dergisi

TOTBİD Dergisi

2018, Cilt 17, Sayı, 4     (Sayfalar: 342-351)

Problems and solution methods in treatment of distal fractures of the femur with intramedullary nails

Mustafa Seyhan 1

1 Acıbadem Üniversitesi, Acıbadem Altunizade Hastanesi, İstanbul

DOI: 10.14292/totbid.dergisi.2018.44
Görüntüleme: 629
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İndirme : 1322

Generally, distal femoral fractures are due to high-energy trauma in young people but low-energy trauma in elderly. In the fractures that extend into the knee joint, it is useful to take computed tomography in addition to double-sided X-ray. In distal fractures of femur, gastrocnemius causes recurvatum and quadriceps causes shortness. Reduction maneuvers and treatment procedure should be planned for correcting these deformities. Putting aside locking plates, intramedullary nailing is a good alternative treatment option for its biomechanical advantages. In extraarticular distal femur fractures and partial intraarticular fractures with a single intercondylar fracture line, excellent results are achieved with appropriately performed retrograde intramedullary nailing. Operation is performed in supine position with medial arthrotomy with a radiolucent elevator put below the knee. The most important potential problem in surgery is reduction. First of all, manual traction is used to avoid shortness, and an elevator below the knee is used to correct recurvatum. If reduction fails, as deformity requires, ball spike pusher, reduction clamp, femoral distractor, skeletal traction from anterior side of distal fragment, and blocking screw from the opposite direction of displacement can be used. Operation is performed with scope from beginning to end. The right entering spot should be chosen, nail length and thickness should be appropriate. Diameter of the nail should be 1.0 or 1.5 mm thinner than the largest drill used. Nail shouldn`t extend into the knee joint. Distal locking is done with external guides, and proximal locking is done with freehand techniques, more often in anterior-posterior direction. Especially in osteoporotic fractures, spiral blade design is preferred because it provides strong multiplanar stability. Length and rotation should be adjusted by comparing with the healthy side. If an obvious difference in length and rotation is observed after the surgery, the problem should be solved by replacing proximal locking screws.

Anahtar Kelimeler : retrograde nailing of distal femoral fracture; intramedullary nailing of distal femoral fracture; distal femur fracture