Intramedullary Nailing of Complete Articular Distal Femur Fractures

Complete articular distal femur fractures can provide challenges for internal fixation due to metaphyseal comminution, intra-articular involvement, osteoporotic bone, and unopposed muscle forces. While the use of lateral locked plating has improved the ability to treat these fractures, recent reports have indicated a high rate of complications using this fixation method, including nonunion rates ranging from 10%-20%. Several biomechanical studies have demonstrated superior results of retrograde intramedullary nails compared to lateral locked plating. To address the unsatisfactory results using lateral locked plating for complete articular distal femur fractures, we have shifted toward stabilization of these injuries with retrograde intramedullary nails augmented with independent screw fixation for the articular injury. Our early clinic results have been promising with regards to maintaining anatomical alignment without loss of fixation. Future long-term outcome studies will be necessary to further assess the success of this treatment method for these difficult injuries.