Key result
Antegrade intramedullary nailing resulted in significantly better knee function compared to retrograde nailing for femoral shaft fractures (mean Lysholm score 94.05 vs 82.45; P<0.0001).
Why the study?
Antegrade reamed interlocked intramedullary nailing is the standard of care for femoral diaphyseal fractures, but retrograde intramedullary nailing has emerged as an alternative, prompting evaluation of functional knee outcomes between the approaches.
Does antegrade intramedullary nailing improve knee functional outcomes compared to retrograde nailing in adults with femoral shaft fractures?
RCT (n=40)
closed envelope technique
Does antegrade intramedullary nailing improve knee functional outcomes compared to retrograde nailing in adults with femoral shaft fractures?
Absolute Event Rate: 94.05% vs 82.45%
p-value: p=<0.0001
Antegrade intramedullary nailing provides superior long-term knee functional outcomes compared to retrograde nailing for femoral shaft fractures.
Antegrade nailing improves knee function over retrograde in femoral shaft fractures; supports antegrade preference in practice and future trials.
ObjectivesTo evaluate functional outcomes of the knee after antegrade and retrograde intramedullary nailing for femoral shaft fractures in adults.BackgroundAntegrade reamed interlocked intramedullary nailing is the treatment of choice for femoral diaphyseal fractures. More recently, retrograde intramedullary nailing of the femur has been seen as a viable alternative to the antegrade nailing.Patients and methodsThis was a prospective comparative study. A total of 40 patients were divided randomly by a closed envelope technique into two equal group: group A (antegrade nailing) and group B (retrograde nailing). A total of 20 patients with shaft femur fractures had interlocking intramedullary fixation via the antegrade nailing approach (group A), whereas another 20 patients with shaft femur fractures had fixation via the retrograde approach (group B).ResultsThe mean age of group A was 25.10 ± 10.41 years and 31.35 ± 10.11 years in group B. There were no significant adverse effects reported in both groups. The mean follow-up duration was 25.20 ± 8.39 months in group A and 25.00 ± 6.91 months in group B (P = 0.759). The mean Tegner Lysholm knee scoring scale was 94.05 ± 4.43 in group A and 82.45 ± 8.83 in the group B (P < 0.0001). Regarding Tegner Lysholm knee scoring scale categorization, group A recorded 90% as excellent, whereas group B revealed 65% as good.ConclusionOur study suggests that antegrade intramedullary femoral nailing fixation is favorable over retrograde nailing in knee function, range of motion, and knee pain for diaphyseal femoral fracture in adults using Lysholm knee function scoring.
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El-Sheikh et al. (2022) conducted an RCT in femoral shaft fractures (n=40). Antegrade intramedullary nailing vs. Retrograde intramedullary nailing was evaluated on Tegner Lysholm knee scoring scale (p=<0.0001). Antegrade intramedullary nailing resulted in significantly better knee function compared to retrograde nailing for femoral shaft fractures (mean Lysholm score 94.05 vs 82.45; P<0.0001).
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