A CLINICAL STUDY OF THE SURGICAL MANAGEMENT OF SUPRACONDYLAR FRACTURE FEMUR BY RETROGRADE INTRAMEDULLARY (GSH) INTERLOCKING NAIL

Abstract

INTRODUCTION .
In the early 1960s, there was a great reluctance towards operative
management of this fracture because of high incidence of infection,
non-union, malunion, inadequate xation and lack of proper
instruments, implant as well as antibiotics. The traditional
management of displaced fracture supracondylar of femur was along
the principle of Watson Jones1 & John Charnley2. This comprised of
skeletal traction, manipulation of fracture and external immobilization
in the form of casts and cast bracings. These methods however, met
with problems like deformity, shortening, prolonged bed rest, knee
stiffness, angulation, joint incongruity, malunion, quadriceps wasting,
knee instability and post-traumatic osteoarthritis. The trend of open
reduction and internal xation has become evident in the recent years
with good results being obtained with the AO blade plate, dynamic
condylar screw and other implant systems like intramedullary
supracondylar nails. Supracondylar fractures tend to collapse into
varus. During application of AO blade plate or dynamic condylar
screw, the shaft of femur is often pulled laterally displacing the line of
weight bearing, lateral to the anatomic axis of condyle. This creates
rotational movements at the fracture site that causes pulling off the
blade plate or condylar screws leading to fatigue fracture of the plates.
Also, the presence of osteoporotic bone leads to xation failures with
screws and plates cutting of the soft bone. The obvious advantage of an
intramedullary device is that it aligns the femoral shaft with condyles
reducing the tendency to place varus movement at the fracture site.
And because the bending movement of an intramedullary device is
substantially reduced failure of xation in osteoporotic bone should be
less. In addition, a retrograde intramedullary supracondylar nail has
got distinct advantages of preservation of fracture hematoma,
decreased blood loss, minimal soft tissue dissection, less operative
time and reduced rate of infection. The purpose of this study is to
evaluate the results of supracondylar and intercondylar fracture of
femur, treated by closed / open reduction and internal xation using
retrograde intramedullary GSH interlocking nail.