Retrograde intramedullary nailing of supracondylar femur fractures above total knee arthroplasty. A preliminary report of four cases.

Four supracondylar fractures of the femur in three patients with total knee arthroplasties were treated by retrograde intramedullary nailing using an interlocking renamed nail (GSH Nail, Smith and Nephew Richards, Memphis, TN) specifically designed for fractures of the distal femur. Three cases were acute fractures and one was a refracture through a screw hole of a previously plated supracondylar fracture. All fractures healed and there were no complications. The procedure is performed by closed nailing using fluoroscopic guidance with the nail placed through the intercondylar notch of the femoral prosthesis and interlocking to the fracture fragments with a percutaneous targeting device. The advantages are that the procedure is performed by closed techniques that preserve the fracture hematoma and reduce operative blood loss, the fracture is stabilized by a load-sharing nail, and immediate motion with limited weight bearing is possible.