Anterograde Interlocked Nailing of Distal Femoral Fractures After Gunshot Wounds

Standard treatment for distal femoral fractures has been with blade plate or condylar screw plate devices. Excellent fixation is obtained, but bone grafting is required and the procedure exposes the fracture site. More recently, indirect methods of reduction have been initiated to limit the devascularization of the fracture site. Anterograde interlocked nailing has the advantage of using an incision far from the fracture site, and the technique is familiar to most surgeons. It can be performed regardless of the degree or length of comminution. Thirty-eight patients 16–50 years of age who underwent anterograde interlocked nailing for fractures of the distal femur were retrospectively studied. Follow-up averaged 24 months. All patients sustained their injury from a gunshot wound (GSW). Thirty-one had angiograms. The distance from the fracture to the distal screws was <5 cm in all cases. There were five Winquist 2, eight Winquist 3, and 25 Winquist 4 type fractures. In five patients the rod tip was cut off to place the screw holes more distally, and in four patients only three corticies were obtained by the distal locking screws. Early motion was obtained in all patients. Fractures healed at an average of 8.6 weeks. No primary or secondary bone grafts were performed. Three of the six patients positioned laterally had 5° or more of valgus angulation, and five of the 34 patients positioned supine had > 5° of posterior angulation. A method of using smooth Steinman pins as joysticks to control the distal fragment is presented. Anterograde interlocked intramedullary (IM) nailing is an effective means of fixation for distal femur fractures.