Retrograde intramedullary nailing for fractures of distal femur: a prospective study


  • Dileep K. S. Department of Orthopaedics, K. S. Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
  • Mahesha K Department of Orthopaedics, K. S. Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India



Distal femur fractures, Retrograde nailing, Union, Functional outcome


Background: The objective of the present study was to evaluate the clinical and functional outcome of retrograde intramedullary interlocking nailing for fractures of distal femur.

Methods: This two-year prospective observational study includes all patients with fractures of distal femur who underwent retrograde intramedullary interlocking nailing.  The patient was placed supine on fracture table with the affected limb flexed to 60o.  Through a transpatellar approach, the nail was introduced in a retrograde method after serial reaming. Postoperatively knee range of motion was started immediately and weight-bearing was progressed after signs of fracture union were noted on x-rays.  The outcome was evaluated for time taken for fracture union, complications and secondary procedures, knee range of motion and function at 1 year follow up using modified knee-rating scale of the hospital for special surgery.

Results: There were 21 patients who underwent retrograde intramedullary nailing for fractures of distal femur during the study period. According to AO/ASIF system, fractures were classified as A1 (n=15), A2 (n=3), and A3 (n=3). In 17 patients, fracture united without complications or secondary procedures. Fractures united at a mean time of 19.4 weeks. There were no varus or valgus malalignments but one patient had significant limb shortening. At the end of 1 year, excellent to good functional outcome was noted in 81% of patients.

Conclusions: Retrograde intramedullary nail fixation is a reliable method for treatment of fractures of distal femur. It promotes high rates of fracture union with minimal complications. This method does not interfere significantly with the knee function postoperatively.


Gurkan V, Orhun H, Doganay M, Salioglu F, Ercan T, Dursum M, et al. Retrograde intramedullary interlocking nailing in fractures of the distal femur. Acta Orthop Traumatol Turc. 2009;43:199-205.

Perren SM. Evolution of internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84:1093-110.

Heirholzer C, von Ruden C, Potzel T, Woltmann A, Buhren. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures. A retrospective analysis. Indian J Orthop. 2011;45:243-50.

Albert MJ. Supracondylar fractures of femur. J Am Acad Orthop Surg. 1997;5:163-71.

Krettek C, Muller M, Miclau T. Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur. Injury. 2001;32(3):14-23.

Ostrum RF, Agarwal A, Lakatos R, Poka A. Prospective comparison of retrograde and antegrade femoral intramedullary nailing. J Orthop Trauma. 2000;14:496-501.

Anup K, Mehra MM. Retrograde femoral interlocking nailing in complex fractures. J Orthop Surg (Hong Kong). 2002;10:17-21.

Patterson BM, Routt ML Jr, Bernischke SK, Hansen ST Jr. Retrograde nailing of femoral shaft fractures. J Trauma. 1995;38:38-43.

Kulkarni SG, Varshneya A, Kulkarni GS, Kulkarni MG, Kulkarni VS, Kulkarni RM. Antegrade Interlocking nailing for distal femoral fractures. J Ortho Surg. 2012;20(1):48-54.

Moed BR, Watson JT. Retrograde intramedullary nailing, without reaming, of fractures of femoral shaft in multiply injured patients. J Bone Joint Surg Am. 1995;77:1520-7.

Demirta AS, Azboy I, Gem M, Alemdar C. Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of distal femur. Acta Orthop Traumatol Turc. 2014;48(5):521-6.

Henderson CE, Lujan T, Bottlang M, Fitzpatrick DC, Madey SM, Marsh JL. Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation. Iowa Orthop J 2010;30:61-8.

Surulivel VJ, Ganesan GR, Rajasekharan R. Dynamic condylar screw versus supracondylar nail in the management of supracondylar fracture distal femur. Int Surg J. 2015;2(3):373-6.

Tornetta P, Tiburzi D. Antegrade or retrograde femoral nailing. A prospective randomized trial. J Bone Joint Surg Br. 2000;82:652-4.






Original Research Articles