The retrograde nail for distal femoral fractures in the elderly: High failure rate of the condyle screw and nut

Displaced distal femoral fractures in elderly patients benefit from surgical fixation. We describe the use of a retrograde femoral nail to treat these fractures. The implant has a special condyle screw and nut that allows for manual compression of the fracture when there is an additional inter-condylar split. We present our results when using this implant to treat 16 patients over a 13-month period. The mean patient age was 78 years (range, 65–96 years). All 16 patients were available at the time of final follow up and proceeded to union at an average time of 11 weeks (range, 10–14 weeks). Twenty-six condyle screw and nuts were used. Ten out of 26 condyle screws in 10 out of 16 patients failed by disengaging at a mean time of 10 weeks (range, 8–12 weeks). Our union rate was unaffected by the nut and bolt disengaging. This would suggest that the condylar compression generated by the nut and bolt may not be critical for union.