Risk of septic knee following retrograde intramedullary nailing of open and closed femur fractures

Jason J Halvorson, Marc Barnett, Ben Jackson, John P Birkedal, Jason J Halvorson, Marc Barnett, Ben Jackson, John P Birkedal

Abstract

Background: One potential complication of retrograde femoral nailing in the treatment of femur fractures is the risk of septic knee. This risk theoretically increases in open fractures as a contaminated fracture site has the potential to seed the instrumentation being passed in and out of the sterile intraarticular starting point. There are few studies examining this potential complication in a relatively commonly practiced technique.

Methods: All patients who received a retrograde femoral nail for femur fracture between September 1996 and November 2006 at a Level 1 trauma center were retrospectively reviewed. This yielded 143 closed fractures, 38 open fractures and 4 closed fractures with an ipsilateral traumatic knee arthrotomy. Patient follow-up records were reviewed for documentation of septic knee via operative notes, wound culture or knee aspirate data, or the administration of antibiotics for suspected septic knee.

Results: No evidence of septic knee was found in the 185 fractures examined in the dataset. Utilizing the Wilson confidence interval, the rate of septic knee based on our population was no greater than 2%, with that of the open fracture group alone being 9%.

Conclusions: Based on these results and review of the literature, the risk of septic knee in retrograde femoral nailing of both open and closed femoral shaft fractures appears low but potentially not insignificant.

Funding: There was no outside source of funding from either industry or other organization for this study.

References

    1. Brick EM. The Intramedullary Nailing of Fractures by G. Kuntscher. Translation of article in Archiv fur Klinische Chirurgie, 200:443, 1940. Clin Orthop Relat Res. 1968;60:5–12.
    1. Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg Am. 1985;67(5):709–720.
    1. Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. a report of five hundred and twenty cases. J Bone Joint Surg Am. 1984;66(4):529–539.
    1. Wolinsky PR, McCarty E, Shyr Y. et al.Reamed intramedullary nailing of the femur: 551 cases. J Trauma. 1999;46(3):392–399. doi: 10.1097/00005373-199903000-00007.
    1. Herscovici D Jr, Whiteman KW. Retrograde nailing of the femur using an intercondylar approach. Clin Orthop Relat Res. 1996;332:98–104.
    1. Handolin L, Pajarinen J, Lindahl J. et al.Retrograde intramedullary nailing in distal femoral fractures-results in a series of 46 consecutive operations. Injury. 2004;35(5):517–522. doi: 10.1016/S0020-1383(03)00191-8.
    1. Holmenschlager F, Piatek S, Halm J. et al.Retrograde intramedullary nailing of femoral shaft fractures. a prospective study. Unfallchirurg. 2002;105(12):1100–1108. doi: 10.1007/s00113-002-0453-0.
    1. Moed BR, Watson JT. Retrograde nailing of the femoral shaft. J Am Acad Orthop Surg. 1999;7(4):209–216.
    1. Ostrum RF, DiCicco J, Lakatos R. et al.Retrograde intramedullary nailing of femoral diaphyseal fractures. J Orthop Trauma. 1998;12(7):464–468. doi: 10.1097/00005131-199809000-00006.
    1. Papadokostakis G, Papakostidis C, Dimitriou R. et al.The role and efficacy of retrograding nailing for the treatment of diaphyseal and distal femoral fractures: a systematic review of the literature. Injury. 2005;36(7):813–822. doi: 10.1016/j.injury.2004.11.029.
    1. Patterson BM, Routt ML Jr, Benirschke SK. et al.Retrograde nailing of femoral shaft fractures. J Trauma. 1995;38:38–43. doi: 10.1097/00005373-199501000-00012.
    1. Ricci WM, Bellabarba C, Evanoff B. et al.Retrograde versus antegrade nailing of femoral shaft fractures. J Orthop Trauma. 2001;15(3):161–169. doi: 10.1097/00005131-200103000-00003.
    1. Sanders R, Koval KJ, DiPasquale T. et al.Retrograde reamed femoral nailing. J Orthop Trauma. 1993;7(4):293–302. doi: 10.1097/00005131-199308000-00001.
    1. Swiontkowski MF, Hansen ST Jr, Kellam J. Ipsilateral fractures of the femoral neck and shaft. a treatment protocol. J Bone Joint Surg Am. 1984;66(2):260–268.
    1. Tornetta P, Tiburzi D. Antegrade or retrograde reamed femoral nailing. a prospective, randomised trial. J Bone Joint Surg Br. 2000;82(5):652–654. doi: 10.1302/0301-620X.82B5.10038.
    1. Lucas SE, Seligson D, Henry SL. Intramedullary supracondylar nailing of femoral fractures. a preliminary report of the GSH supracondylar nail. Clin Orthop Relat Res. 1993;296:200–206.
    1. 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(4):453–458.
    1. O'Toole RV, Riche K, Cannada LK, Hennessy M, Sciadini MF, Shi LL, Woodford M, Harris MB. Analysis of postoperative knee sepsis after retrograde nail insertion of open femoral shaft fractures. J Orthop Trauma. 2010;24(11):677–682. doi: 10.1097/BOT.0b013e3181cec32c.

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