Abstract
This is a retrospective study of 18 patients who had ipsilateral femoral and tibial fractures. They were treated by the retrograde femoral and antegrade tibial intramedullary nail from a single incision in the knee. The average time for union of femoral shaft fractures was 27.6 (18–40) weeks. One patient required antegrade nailing with a bone graft due to metal failure after using the short nail. Two tibial fractures required bone grafting due to bone loss, with an initial open fracture. The average time for union of tibial fractures was 24.5 (18–30) weeks. Functional results using the Karlstrom–Olerud criteria were excellent in 14, good in three, and acceptable in one. The only acceptable result was in a supra- and inter-condylar femoral fracture, with protrusion of the nail tip into the knee joint, which created moderate limitation of knee motion. Simultaneous retrograde femoral and antegrade tibial nailing with a single incision in the knee can achieve satisfactory results in the management of these types of fracture.
Résumé
Etude rétrospective de 18 patients qui avaient une fracture fémorale et tibiale ipsilatérales. Ils ont été traités par enclouage centromédullaire rétrograde fémoral et enclouage antérograde tibial, en utilisant une seule incision sur le genou. Le temps moyen de consolidation des fractures diaphysaires fémorales était de 27,6 (18–40) semaines. Un malade a nécessité un enclouage antérograde avec greffe osseuse à cause de l’échec dû à l’utilisation d’un clou trop court. Deux fractures tibiales ont nécessité une greffe osseuse à cause de la perte de substance dûe à une fracture ouverte initiale. Le temps moyen de consolidation des fractures tibiales était de 24,5 (18–30) semaines. Les résultats fonctionnels, avec les critères de Karlstrom–Olerud étaient excellents dans 14 cas, bon dans trois et médiocre dans un cas. Le seul résultat médiocre était aprés une fracture sus et intercondylienne fémorale, avec issue de l’extrémité du clou dans l’articulation du genou, créant une limitation modéré de la mobilité. L’enclouage simultané rétrograde fémoral et antérograde tibial avec une seule incision sur le genou peut donner des résultats satisfaisants dans la gestion de ces fractures.
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Footnotes
This study was conducted at Kyungpook National University Hospital, Daegu, Korea.
References
- 1.Anastopoulos G, Assimakopoulos A, Exarchou E, Pantazopoulos T. Ipsilateral fractures of the femur and tibia. Injury. 1992;23:439–441. doi: 10.1016/0020-1383(92)90058-Z. [DOI] [PubMed] [Google Scholar]
- 2.Baker SP, O’Neill B, Haddon W, Jr, Long WB. The Injury Severity Score. A method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–196. [PubMed] [Google Scholar]
- 3.Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71:336–340. [PubMed] [Google Scholar]
- 4.Gregory P, DiCicco J, Karpik K, DiPasquale T, Herscovici D, Sanders R. Ipsilateral fractures of the femur and tibia: treatment with retrograde femoral nailing and unreamed tibial nailing. J Orthop Trauma. 1996;10:309–316. doi: 10.1097/00005131-199607000-00004. [DOI] [PubMed] [Google Scholar]
- 5.Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–458. [PubMed] [Google Scholar]
- 6.Hee HT, Wong HP, Low YP, Myers L. Predictors of outcome of floating knee injuries in adults: 89 patients followed for 2–12 years. Acta Orthop Scand. 2001;72:385–394. doi: 10.1080/000164701753542050. [DOI] [PubMed] [Google Scholar]
- 7.Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early stabilization of fractures. J Trauma. 1985;25:375–384. doi: 10.1097/00005373-198505000-00001. [DOI] [PubMed] [Google Scholar]
- 8.Karlstrom G, Olerud S. Ipsilateral fractures of the femur and tibia. J Bone Joint Surg Am. 1977;59:240–243. [PubMed] [Google Scholar]
- 9.Krettek C, Miclau T, Grun O, Schandelmaier P, Tscherne H. Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury. 1998;29(Suppl 3):C29–C39. doi: 10.1016/S0020-1383(98)95006-9. [DOI] [PubMed] [Google Scholar]
- 10.McAndrew MP, Pontarelli W. The long-term follow-up of ipsilateral tibial and femoral diaphyseal fractures. Clin Orthop. 1988;232:190–196. [PubMed] [Google Scholar]
- 11.Moed BR, Watson JT. Retrograde intramedullary nailing, without reaming, of fractures of the femoral shaft in multiply injured patients. J Bone Joint Surg Am. 1995;77:1520–1527. doi: 10.2106/00004623-199510000-00006. [DOI] [PubMed] [Google Scholar]
- 12.Morgan E, Ostrum R, DiCicco J, McElroy J, Poka A. The effects of a retrograde intramedullary nail on the patello–femoral articulation. J Orthop Trauma. 1999;13:13–16. doi: 10.1097/00005131-199901000-00004. [DOI] [PubMed] [Google Scholar]
- 13.Oh CW, Park BC, Ihn JC, Park HJ. Primary unreamed intramedullary nailing for open fractures of the tibia. Int Orthop. 2001;24:338–341. doi: 10.1007/s002640000174. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.OrthopaedicJ Orthop Trauma 199610v8814583 [Google Scholar]
- 15.Ostrum R, DiCicco J, Lakatos R, Poka A. Retrograde intramedullary nailing of femoral diaphyseal fractures. J Orthop Trauma. 1998;12:464–468. doi: 10.1097/00005131-199809000-00006. [DOI] [PubMed] [Google Scholar]
- 16.Paul GR, Sawka MW, Whitelaw GP. Fractures of the ipsilateral femur and tibia: emphasis on intra-articular and soft tissue injury. J Orthop Trauma. 1990;4:309–314. doi: 10.1097/00005131-199004030-00013. [DOI] [PubMed] [Google Scholar]
- 17.Theodoratos G, Papanikolaou A, Apergis E, Maris J. Simultaneous ipsilateral diaphyseal fractures of the femur and tibia: treatment and complications. Injury. 2001;32:313–315. doi: 10.1016/S0020-1383(00)00189-3. [DOI] [PubMed] [Google Scholar]
- 18.Veith RG, Winquist RA, Hansen ST. Ipsilateral fractures of the femur and tibia. A report of fifty-seven consecutive cases. J Bone Joint Surg Am. 1984;66:991–1002. [PubMed] [Google Scholar]
- 19.Winquist RA, Hansen ST, Clawson DK. Closed intramedullary nailing of femoral fractures: a report of 520 cases. J Bone Joint Surg Am. 1984;66:529–539. [PubMed] [Google Scholar]
- 20.Yokoyama K, Tsukamoto T, Aoki S, Wakita R, Uchino M, Noumi T, Fukushima N, Itoman M. Evaluation of functional outcome of the floating knee injury using multivariate analysis. Arch Orthop Trauma Surg. 2002;122:432–435. doi: 10.1007/s00402-002-0406-7. [DOI] [PubMed] [Google Scholar]