Abstract
Purpose
To analyze the factors that cause a posterior angulatory deformity in the retrograde intramedullary nailing of distal femoral fractures.
Materials and Methods
Fifty-five patients with distal femur fractures who were treated with retrograde intramedullary nailing were enrolled in this study. They were followed-up for at least one year postoperatively. The posterior angulatory deformity was evaluated according to the fracture location, pattern, and insertion point and the insertion point was compared with the ideal point derived from the radiographs of 100 normal adults. The correlation between the posterior angulation and the entry point of the nail was analyzed.
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References
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![]() | Fig. 1.Method of measuring the distance between the intramedullary center line and apex of the Blumensaat's line: (A) practical measurement, (B) schematic drawing. |
![]() | Fig. 2.Entry point of the retrograde intramedullary nail, which could affect the posterior angulation of the fracture: (A) The 8.16 mm anterior location of entry point with no posterior angulation of fracture site was observed. (B) The 7.81 mm posterior location of entry point with posterior angulation. |
![]() | Fig. 3.Method for measuring the posterior angulation of the fracture site: That could be measured from the angle between an intramedullary center line of the distal fragment and that of the proximal fragment. This patient had malunion of 12.6o posterior angulation. |
![]() | Fig. 4.Fracture level as a factor that could affect the posterior angulation of the fracture: (A) supracondylar level (AO 33 type), (B) distal one third level of femoral shaft (AO 32 type). |
![]() | Fig. 5.Facture pattern as a factor that could affect the posterior angulation of a fracture: (A) transverse type, (B) oblique type, (C) spiral type, and (D) comminuted type. |
Table 1.
Posterior Angulation of a Distal Femoral Fracture according to the Fracture Level and Pattern
Factor | Posterior angulation (o) | p-value |
---|---|---|
Fracture level | 0.708* | |
Shaft (AO/ASIF 32 type) | 2.6±4.1 | |
Supracondylar or intercondylar fracture (AO/ASIF 33 type) | 3.1±3.9 | |
Fracture pattern | 0.047† | |
Transverse | 1.1±2.1 | |
Oblique | 4.0±2.9 | |
Spiral | 4.7±4.9 | |
Comminuted | 5.5±6.8 | |
Entry point | 0.005* | |
Anterior | 1.3±0.7 | |
Non-anterior | ||
Center | 1.5±0.7 | |
Posterior | 9.5±1.4 |