Retrograde nailing of the femur using an intercondylar approach

The standard of care for femoral fractures is an intramedullary nail, placed in an antegrade approach. This has produced high rates of healing and low complication rates. The use of retrograde nailing for femoral shaft fractures is a relatively new technique, previously described as an extraarticular approach. Forty-one patients with 45 fractures were available for assessment after retrograde femoral nailing using an intracondylar approach. There were 2 nonunions, which healed with revision surgery, in addition to 5 other complications including: reflex sympathetic dystrophy, an ileus, deep vein thrombosis, skin loss about the knee, and malrotation noted after initial nailing. There were no postoperative infections, no arthrosis was noted, and flexion of the knee averaged 129 degrees. Retrograde femoral nailing may be used to treat fractures in patients who present with multisystem trauma; multiskeletal trauma, especially peritrochanteric and acetabular injuries; floating knee fractures; bilateral femur fractures; and patients with morbid obesity.