Knee Pain and Leg-Length Discrepancy After Retrograde Femoral Nailing Ricardo Reina, MD, Fernando E
(aspects of trauma • an original study) Knee Pain and Leg-Length Discrepancy After Retrograde Femoral Nailing Ricardo Reina, MD, Fernando E. Vilella, MD, Norman Ramírez, MD, Richard Valenzuela, MD, Gil Nieves, MD, and Christian A. Foy, MD ABSTRACT an antegrade entry point at the pirifor- MATERIALS AND METHODS We retrospectively studied postop- mis fossa.1,2,4,8-12 This technique has Between October 1998 and April 2000, erative knee function and leg-length several drawbacks, including a dif- a surgeon at University of Puerto Rico discrepancy (LLD) in 31 patients ficult starting point at the piriformis District Hospital and Puerto Rico with femoral diaphyseal fractures fossa, postoperative Trendelenburg Medical Center used retrograde IMN treated with retrograde intramedul- gait, iatrogenic fracture of the femo- to treat 46 femoral shaft fractures con- lary nailing (IMN) between October 1998 and April 2000. Mean follow-up ral neck, need for a fracture table secutively. For the purpose of this study, was 25 months, mean knee range of with difficult patient positioning, and we selected only those fractures motion was 126°, mean Hospital for limitations in use with concomitant located both 5 cm below the lesser Special Surgery knee scores were surgical procedures.3,5,6 trochanter14 and above the femoral 89.2 (pain) and 78.3 (function), and Over the past 20 years, retrograde condyles. Patients were contacted by mean LLD was 1.19 cm. Despite the IMN has emerged as an alternative telephone, by mail, or through local theoretically higher knee pain and that overcomes the shortcomings of government agencies. LLD rates associated with retrograde antegrade IMN in treating femoral Of the 46 patients, 15 (33%) were IMN, we believe it may offer a viable shaft fractures.1,3-5,7,8,13,14 The advan- excluded (4 had passed away, and 11 treatment option when the antegrade nailing technique is restricted.
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