The retrograde intramedullary nail: Prospective experience in patients older than sixty-five years

Hypothesis: To determine whether retrograde nailing of distal femoral fractures is beneficial for the elderly patient. Methods: Prospective study of consecutive patients, aged sixty-five years or older, whose distal femoral fractures were treated with a retrograde femoral nail between January 3, 1993, and April 30, 1996. Results: Twenty-four of twenty-six patients were followed for more than twelve months. There were twenty AO/ASIF 33A and four AO/ASIF 33C fractures. Twenty-three were closed. There was one Gustilo type 1 fracture. All fractures healed. Six patients did not walk before injury. Using the Neer scoring system, there were ten (56 percent) excellent (85 or more points), six (33 percent) good (70 or more paints), and two (11 percent) fair (55 or more points) results; none of the cases were considered as failures (less than 55 points). Conclusions: Retrograde intramedullary nailing makes possible a biological osteosynthesis of distal femoral fractures. It also produces good functional results in elderly patients. The two major technical problems encountered with this implant are the poor hold of the distal interlocking screws and difficulties with proximal interlocking. Early weight-bearing is not advisable.