Retrograde dynamic locked nailing for aseptic nonunion of femoral supracondyle after antegrade locked nailing.

Background: Using antegrade exchange locked nailing to treat femoral supracondylar aseptic nonunion may sometimes have some limitations. Using retrograde locked nailing to treat such situations may achieve great advantages. The feasibility of such a technique was investigated.

Methods: Fifteen consecutive adult patients were treated. Indications for this technique were an aseptic nonunion of the femoral supracondyle, an antegradely inserted locked nail, shortening of the femur less than 1.5 cm, and a dilapidated cortex of the distal fragment unsuitable for performing antegrade exchange locked nailing. The technique included the closed removal of all previous implants, insertion of a retrograde dynamic locked nail, cancellous bone grafting from the lateral tibial condyle, and with or without plate augmentation. Early ambulation with protected weight bearing was allowed postoperatively, and knee range of motion exercise was encouraged.

Results: Thirteen patients were followed up for a median of 2.5 years (range 1.1-4.5 years). All fractures were healed with a median union period of 4.5 months (range 3.5-5.5 months). There were no wound infections, nonunions or malunions. The knee function satisfactorily improved from none to 11 out of 13 patients (p < 0.001).

Conclusions: Retrograde dynamic locked nailing is an excellent alternative treatment for the treatment of aseptic nonunions of femoral supracondyles after antegrade locked nailing. However, this technique may only be used when antegrade exchange locked nailing is unsuitable for use. The technique is not complex and its success rate is high.