Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture

Chang-Wug Oh; Jong-Keon Oh; Woo-Kie Min; Shin-Yoon Kim; Seung-Hoon Baek; Byung-Chul Park; Hyung-Soo Ahn; Tae-Gong Kim

doi:10.12671/jkfs.2007.20.2.135

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Oh, Oh, Min, Kim, Baek, Park, Ahn, and Kim: Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture

Original Article

Journal of the Korean Fracture Society 2007; 20(2): 135-140.

Published online: 14 June 2016

DOI: https://doi.org/10.12671/jkfs.2007.20.2.135

Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture

Chang-Wug Oh, M.D., Jong-Keon Oh, M.D.^*, Woo-Kie Min, M.D., Shin-Yoon Kim, M.D., Seung-Hoon Baek, M.D., Byung-Chul Park, M.D., Hyung-Soo Ahn, M.D.^**, Tae-Gong Kim, M.D.

Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, School of Medicine, Seoul, Korea.

^*Department of Orthopedic Surgery, School of Medicine, Korea University, Seoul, Korea.

^**Department of Anatomy, School of Medicine, Kyungpook Natiorial University, Daegu, Korea.

Address reprint requests to: Chang-Wug Oh, M.D. Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 101, Dongin-dong 2-ga, Jung-gu, Deagu 700-422, Korea. Tel: 82-53-420-5630, Fax: 82-53-422-6605, cwoh@knu.ac.kr

Abstract

Purpose

To compare retrospectively the antegrade and retrograde nailing in the management of ipsilateral femoral neck and shaft fractures.

Materials and Methods

Thirty-two patients (thirty-three injuries) were included in this study. Mean age of patients was 38 years-old in the antegrade nailing group (16 injuries) and 44 years-old in the retrograde nailing group (17 injuries). We compared the union of fractures and complications between two groups, and investigated the influencing factors.

Results

Femoral shaft fracture was united in 10 cases (63%) of antegrade group and 12 cases (71%) of retrograde group, at 28.2 and 27.3 weeks respectively. Nonunion was more prevalent in Winquist-Hansen III and IV (5 in antegrade nailing, 3 in retrograde nailing) than I and II. Femoral neck fracture was united with 1 case of nonunion in each group. Nonunion developed from Garden stage IV, but fractures of Garden stage I and II united regardless of methods.

Conclusion

In ipsilateral femoral neck and shaft fractures, the kinds of methods did not affect the results of shaft fractures. Minimally displaced neck fractures also were not influenced by kinds of methods, but retrograde nailing may have a benefit in fixing the displaced neck fractures

Keywords: Ipsilateral femoral neck and shaft fractures, Retrograde nailing, Antegrade nailing

Figures and Tables

Fig. 1

(A) A 29-year-male with femur shaft fracture.

(B) Postoperatively, femur neck fracture was found on the radiograph (arrow) and CT image.

(C) Fourteen days after initial operation, fixation was done with three screws anterior to the femoral nail.

Fig. 2

(A) At 2 month, femoral neck fracture healed and callus is forming on the shaft fracture.

(B) At 6 month, all fractures healed uneventfully without leg length discrepancy.

Fig. 3

(A) A 61-year-man with ipsilateral fractures of femoral shaft and neck.

(B) Retrograde nailing of the shaft and screw fixation of the neck was done.

Fig. 4

At 5 month, fractures healed uneventfully.

Fig. 5

(A) 24 years old female with femur shaft fracture and ipsilateral displaced neck fracture.

(B) Antegrade nailing and screw fixation of the neck was done. Due to the preinserted nail, there were some difficulties in screw fixation.

Fig. 6

(A) At 3 months after surgery, the neck fracture displaced with loosening of the screws.

(B) Using dynamic hip screw and dynamic compression plate, revision procedure was done on both fractures.

(C) At 7 month after 2nd operation, both fractures healed.

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