Abstract
Purpose of the study: The relative role for anterograde nailing in relation to retrograde nailing has become a highly debated issue. Bifemoral fractures would appear to be a priority indication for the later method.
Material and methods: From January 1997 to December 2003, 19 bifemoral shaft fractures were treated by simultaneous retrograde nailing (group 1, eight cases, five males, three females) or by anterograde nailing in a one-stage procedure (group 2, eleven cases, six males, five females). Patient age was 23 years 7 months on average (range 16.6–40.5 years) in group 1 and 26 years 7 months (range 17.8–42.3 years) in group 2. The ISS was 30.6 (13–50) in group 1 and 16.8 (10–27) in group 2.
Results: The time for installation of the two femurs was 30 min (range 20–40 min) in group 1 and 70 min (range 60–80 min) in group 2. The operative time for the two femurs was 144 min (range 110–170) in group 1 and 156 min (range 140–180 min) in group 2. One patient in group 1 died on day 2 postop; none in group 2. First-intention bone healing was achieved at 14 weeks (range 12–16) in all patients in group 1. In group 2, there were two nail replacements and two grafts. Healing time was 24 weeks (range 10–130). Follow-up was 24 months (range 13–54 months). Knee flexion was 138° (range 130–140°) in group 1 (removal of patellar tendon calcification in one patient) and 123° (range 110–150°) in group 2. The difference in length between the two femurs was 6.2 mm (range 0–6 mm) in group 1 and 5.3 mm (range 0–11 mm) in group 2. The functional outcome (Thorensen criteria) was excellent in nine femurs, good in five in group one and excellent in nine, good in nine and fair in four in group 2.
Conclusion: Retrograde nailing provides clinical and radiographic results which are comparable to antero-grade nailing. However, the time required and the ease of installation is in favor of retrograde nailing.
Correspondence should be addressed to SOFCOT, 56 rue Boissonade, 75014 Paris, France.
