Abstract
Purpose: This paper reports 15 cases of femoral supracondylar distal diaphyseal fracture treated with retrograde intramedullary nailing at our hospital since 1992.
Methods: The present cases were classified into bone fracture types according to the AO classification system and assessed with Neer's bone fracture assessment table.
Results: According to the AO classification system, the study population comprised 4 patients with grade 33.A.1 fracture, 3 with 33.A.2, 2 with 33.A.3, 1 with 33.C.2, 2 with 33.C.3, 2 with 32.B.2, and 1 with 32.C.2, including 2 patients with open fracture and 2 patients with accompanying ipsilateral tibial plateau fracture. According to Neer's bone fracture assessment table, 5 cases were rated“excellent, ”5“satisfactory, ”1“unsatisfactory, ”and 2“failure ; ”in 2 cases assessment was impossible owing to disuse of the limb. The 2 cases rated“failure”were a case in which early training for extended range of motion had been impossible owing to multiple wounds and another case in which the nail had broken.
Discussion: In distal diaphyseal fractures, anatomical reduction is easily achieved. In supracondylar fractures, in particular, it was anticipated that reduction depended to some extent on the direction of guide pin insertion. In cases of severe comminution in the diaphyseal/supracondylar portion, lateral stopping with careful consideretion of shortening is essential. Ipsilateral tibial plateau fracture prevented a satisfactory range of motion from being achieved. Nail breakage is attributable to stress on the lateral stopping hole on the fracture line.
