Retrograde femoral nailing in elderly patients with supracondylar fracture femur; is it the answer for a clinical problem?

Background: Supracondylar fractures of femur constitute 7% of all femoral fractures. In elderly patients, they are invariably low-energy fractures predisposed to by osteoporosis. Treatment of these fractures in the elderly is a challenging task for most orthopaedic surgeons. There is no consensus on what would be the ideal treatment for such cases. This study looks at the results of retrograde femoral nailing as a treatment option for this vulnerable group of patients.

Patients And Methods: This retrospective study looks at 23 elderly patients with supracondylar fractures of the femur treated by retrograde femoral nailing. Patients had an average age of 75 years (range between 65 years and 97 years). All patients were assessed with regard to operative time, blood loss, hospital stay, and postoperative complications. All patients were assessed clinically and radiologically every 6 weeks for average period of 14 months (range 12 to 18 months).

Results: two patients died a few weeks postoperatively. Average operative time 70 minutes, average blood loss 350ml. Radiologically all cases united, 39.2% had angular malalignment. There were no cases of implant or fixation failure.

Conclusion: Retrograde femoral nailing is a surgically limited and reliable procedure for elderly patients with supracondylar fractures of the femur without intra-articular extension. Although it has a high incidence of angular malalignment, the overall functional demands of this age group are perhaps not affected much by that particular complication.