Retrograde Femoral Nailing and Knee Function

Abstract

This study compares the functional outcomes of retrograde and antegrade femoral nailing for femur shaft fractures. Thirty-two patients who underwent femoral nailing for femur shaft fractures at 2 urban level I trauma centers were evaluated retrospectively. Fourteen nails were inserted retrograde (13 patients) and 19 were inserted antegrade. A comparison of clinical outcomes between retrograde and antegrade nailing was performed. Data collected included patient demographics, injury and treatment details, Injury Severity Scores (ISS), New Injury Severity Scores (NISS), hospital length of stay, intensive care unit length of stay, and complications and reoperations. Knee and hip function was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS). A complete physical examination of the knee and hip was performed. Data analysis was performed using nonparametric tests. The average time to follow-up was 48.2 months. The 2 groups were not equivalent with respect to hospital length of stay, number of additional injuries and surgeries, and fracture location. The groups were equivalent with respect to age, time to follow-up, ISS, NISS, and intensive care unit length of stay. Knee scores and knee range of motion (ROM) were significantly worse in the retrograde group. Hip function was not significantly different between groups.