From October 1988 to April 2000, 7 patients with 7 distal femoral fractures were treated with a retrograde intramedullary nail. The average age was 68 years. The average follow-up interval was 11.6 months. The average operation time was 94 minutes and the average estimated blood loss was 105g except 1 patient who had ipsilateral tibial plateau fracture as well. On average, postoperative partial weight-bearing began at 6 weeks and range of motion exercise began at 6.4 days. The average knee flexion at the most recent evaluation was 106°.
Distal locking screws broke in two cases. The failure were apparently caused by the length, the position and the strength of the distal locking screws, and by inadequate weight-bearing. After distal locking screws broke, those fractures healed.
The average ROM was fair. That was apparently affected by soft tissue damage and adhesion, and arthrotomy.
Retrograde intramedullary nailing is useful for distal femoral fractures in elderly patients, however, those with poor callus development require appropriate dynamization to prevent breakage of the distal locking screws.
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