Object: We performed retrograde nailing of type C fractures and periprothetic percondylar fractures of the distal femur using a new dedicated femoral implant (T2 Supra-Condylar Nail). Herewith a powerful tool for the treatment of complex very distal femoral fractures was created. This nail has four distal locking holes placed from 6 to 32 mm at the end of the nail for a 3 plane fixation.
We present the new implant and the preliminary clinical outcome in 25 cases.
Methods: A consecutive series of 24 patients with 25 fractures of the distal femur (6 fractures AO type A, 1 type B, 12 type C fractures and 6 periprothetic fractures) was operated between January 2003 and September 2004. The epidemiology was typical for trauma patients with 18 male and 6 female patients. The mean age was 50.8 years (range 21–92 ys). The bone stock was osteopenic in 9 cases and regular in 16 cases. There were 6 patients who sustained polytrauma, 5 paraplegic patients fell out of their wheelchair. The remaining 13 patients suffered isolated injuries.
The patients were followed up clinically and radiographically.
Results: Seven patients were stabilized intramedullary at the day of the accident, 11 patients in the next 5 days. The remaining 6 fractures were initially stabilized with an external fixator in case of multiple injury. 7 percondylar fractures were stabilized with a short nail of 200 mm in cases of implants in the proximal femur (hip prosthesis: 3, DHS: 2, gamma nail: 2).
Mean duration of operation was 106 minutes.
The retrograde nailing using the T2 implant is a good suitable method performing a correct reposition of the fragments with high primary stability. There were no problems in woundhealing at all. Postoperatively a wheightbearing mobilisation with 20kg was possible and range of motion was unlimited.
Radiographs showed better ossification compared with plate osteosynthesis. Only one nail is broken out and needed a corrective operation with a plate. We saw no greater X- or O-deformity or rotation divergence. Only in 3 cases of delayed union, a spongioaplasty was indicated.
Conclusions: The retrograd nailing of distal femoral fractures type A is well accepted. After changing a C fracture in A fracture, it is also possible to stabilize complex intraarticular fractures intramedullarly. If a stabile metaphyseal block of minimal 3,5 centimeter is present after anatomical reconstruction of the joint, even in cases of osteoporotic bone stock, a intramedullary nailing is possible. Also in cases of periprothetic fractures with a short metaphyseal block of the distal femur, the T 2 supracondylar nail with its 4 locking screws at the end of the nail can stabilize this block in a 3 plane fixation.
