Retrograde Nailing in Multiple Injured Patients

Introduction

Because of the threat of multiple organ failure and ARDS, early stabilisation of fractures of the femur is very important in the treatment of multiple injured patients.

In the University Hospital Groningen we have been performing for 12 years intramedullary stabilisation of fractures of the femur in multiple injured patients. Since 1995 we use the unreamed femoral nail. The stabilisation can be done in a lateral position without a traction table.

However, the lateral position or a traction table can be a danger for injuries of the thorax, pelvis, spine and contralateral fractures.

Retrograde stabilisation of the femur can be done in a supine position without a traction table. Exposure of the entry point of the nail through a small medial arthrotomy of the knee is very easy. A fracture of the tibia can be stabilised intramedullary through the same incision. A retrograde nail does not interfere with a screw stabilisation of a femoral neck fracture.

Disadvantages of the retrograde technique are the danger of infection of the knee and cartilage damage.

After discussing the advantages and disadvantages of retrograde nailing we decided to use this technique in:

Fractures of the femur with a pelvis, thorax or spine injury. Bilateral fractures of the femur. Ipsilateral fracture of the tibia. Ipsilateral femoral neck fracture.