Extra articular distal femoral fractures in the elderly treated with retrograde nailing using a spiral-locking blade system

Abstract

Background: The number of elderly patients sustaining long bone fractures is increasing with the rise of elderly population in the western world. Management of distal femur fractures is particularly difficult due to osteoporosis and other associated comorbidities. The key to management would be by surgical stabilization, which allows early mobilization. This study was devised to look into the radiological outcome and complication rate in a series of elderly patients who were treated with retrograde nail using spiral locking blade system for extra articular distal femur fractures. Materials and Methods: This is a retrospective study of patients who have undergone retrograde nailing with spiral-locking blade for distal femoral fractures (extra articular) above the age of 70 years in a major trauma center from 2001 to 2015. Notes were assessed for postoperative complications; time to union and final postoperative followup radiographs were assessed for alignment using a scoring system. Results: Forty one patients with an average age of 80 years and an average followup period of 9 months were included. The mean radiological score at final followup was 10.34 (range 8-12), with no significant shortening in any of the patients. Thirty patients had excellent radiological score (>10) and 11 patients scored good (8-9). The difference in time to union between Group 1-simple fracture pattern (3.42 months) and Group 2-complex comminuted fracture pattern (4.74 months) was not statistically significant (P = 0.072). There were five delayed unions but no cutout or metal work failure. Conclusion: The retrograde femoral nail with distal spiral-locking blade system can be a good surgical option for the treatment of extra articular distal femoral fractures in the elderly with the possibility of early weightbearing.