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Review paper

Feasibility and value of non-locking retrograde nail vs. locking retrograde nail in fixation of distal third femoral shaft fractures: radiographic, bone densitometry and clinical outcome assessments

By
Michele Bisaccia Orcid logo ,
Michele Bisaccia
Contact Michele Bisaccia

Division of Orthopaedics and Trauma Surgery, University of Perugia, “S. Mariadella Misericordia” Hospital, Perugia, Italy

Auro Caraffa ,
Auro Caraffa

Division of Orthopaedics and Trauma Surgery, University of Perugia, “S. Mariadella Misericordia” Hospital, Perugia, Italy

Giuseppe Rinonapoli ,
Giuseppe Rinonapoli

Division of Orthopaedics and Trauma Surgery, University of Perugia, “S. Mariadella Misericordia” Hospital, Perugia, Italy

Giovanni Battista Mancini ,
Giovanni Battista Mancini

Department of Orthopaedics and Traumatology, San Matteo degliInfermi Hospital, Spoleto, Italy

Giuseppe Rollo ,
Giuseppe Rollo

Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy

Miguel Carrato-Gomez ,
Miguel Carrato-Gomez

Division of Orthopaedics and Trauma Surgery, Hospital Virgen de la Salud, Toledo, Spain

David Gomez-Garrido ,
David Gomez-Garrido

Division of Orthopaedics and Trauma Surgery, Hospital Quirónsalud y Hospital Laboral Solimat, Toledo, Spain

Cristina Ibáñez-Vicente ,
Cristina Ibáñez-Vicente

Department of General Medicine, “Hospital de Getafe”, Madrid, Madrid, Spain

John W. Trilleras-Berrío ,
John W. Trilleras-Berrío

Division of Orthopaedics and Trauma Surgery, Hospital Virgen de la Salud, Toledo, Spain

Valerio Pace ,
Valerio Pace

Division of Orthopaedics and Trauma Surgery, University of Perugia, “S. Mariadella Misericordia” Hospital, Perugia, Italy

Raffaele Franzese ,
Raffaele Franzese

Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Naples, Iceland

Mariagiovanna Vastarella ,
Mariagiovanna Vastarella

Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Naples, Italy

Gorizio Pieretti ,
Gorizio Pieretti

Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Naples, Italy

Giacomo Errico ,
Giacomo Errico

Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Naples, Italy

Luigi Meccariello
Luigi Meccariello
Contact Luigi Meccariello

Department of Orthopaedics and Traumatology, San Matteo degliInfermi Hospital, Spoleto, Italy

Abstract

Aim
Distal femoral shaft fractures are characterized by increasing incidence and complexity and are still considered a challenging problem. No consensus on best surgical option has been achieved. The aim of this study is to investigate mineral bone densitometry, radiographic and clinical outcomes of locking retrograde intramedullary nailing (LRN) and non-locking retrograde intramedullary nailing (NLRN) regarding surgical treatment of distal femoral shaft fractures in adults based on the hypothesis that there is no statistical difference among the results of both surgical options.
Methods
Retrospective study: 30 patients divided into 2 groups (Group 1 LRN, Group 2 NLRN). Average age was 42.67±18.32 for Group 1 and 44.27±15.11 for Group 2 (range of age 18-65 for both groups). Gender ratio (male:female) was 2.75 (11:4) for both groups. AO Classification, Non Union Scoring System (NUSS) and Radiographic Union Score Hip (RUSH), Visual Analogic Score (VAS), Dexa scans, plain radiographs were used. Evaluation endpoint: 12 months after surgery.
Results
No statistical difference was obtained in terms of surgery time, transfusions or wound healing. There were similar results regarding average time of bone healing, RUSH scores, VAS, regression between RUSH and VAS, average correlation clinical-radiographic results and patients outcomes. Only one patient of LRN group had reduction of mineral bone densitometry values.
Conclusion
No statistical difference in terms of radiographic, bone densitometry and clinical outcomes among LNR and NLNR for the treatment of distal femur fractures was found. The presence of no statistical difference regarding radiological findings is the main factor supporting our hypothesis given their strong objectivity.

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