Treatment of distal femoral fractures in the elderly. Results with the retrograde intramedullary supracondylar nail.

The drawbacks of plating techniques for the treatment of distal femoral fractures are the need for a large exposure with the possible risk of soft tissue damage, devascularisation of bone fragments and loss of the possible positive effect of the fracture hematoma. Moreover, early weight bearing is not advisable with these implants. To find out whether the retrograde nailing of distal femoral fractures is beneficial we performed this study. Between March 1, 1993 and September 1, 1995, 25 patients with 26 distal femoral fractures were treated in our department with retrograde femoral nailing. According to the ASIF-classification we classified 20 fractures as supracondylar A fractures and 6 fractures as intercondylar C fractures. All fractures were closed and without important soft tissue damage. One patient dies of a not fracture-related cause before fracture healing was achieved. Twenty-five fractures healed. According to our relative Neer-score we counted 18/25 (72%) excellent results (> or = 85 points), 5/25 (20%) good results (> or = 70 points), 1 (4%) fair result (> or = 55 points and 1 (4%) bad result (< 55 points). The retrograde intramedullary nailing makes a biological osteosynthesis of distal femoral fractures possible. Also in our aged patients good functional results could be obtained. Poor hold of the distal interlocking screws and difficult interlocking are the 2 major technical problems encountered with this implant. Early weight bearing is not advisable.