A Short-term Clinical Efficacy Of Antegrade Nailing Vs Retrograde Nailing In The Treatment Of Infra-isthmal Femoral Shaft Fractures

Objective: Intramedullary nails have become main-stream in the treatment of Infra-isthmal femoral shaft fractures.However,how to choose the femoral shaft antegrade intramedullary nail and retrograde intramedullary nail has not been reported yet.This study aims to compare the short-term clinical efficacy of antegrade intramedullary nails and retrograde intramedullary nails in the treatment of Infra-isthmal femoral shaft fractures,in order to provide more options for clinical treatment.Methods: Retrospective analysis was performed on 114 patients with Infra-isthmal femoral shaft fracture who received surgical treatment from December 2015 to May 2019,there were 92 cases successfully underwent surgery,and 53 cases were finally followed up.According to different treatment methods,they were divided into anterograde group(n = 30)and retrograde group(n = 23).There were 18 males and 12 females in anterograde group.Their age ranged from 34 to 70 years old,with an average of(48.35±9.14)years old.Fracture AO/OTA classification: 31 A type 15 cases,31 B type 11 cases,31 C type 4 cases.In retrograde group,there were 16 males and 7 females.The average age was(35.83±7.91)years from 25 to 54 years.Fracture AO/OTA classification: 31 A type 10 cases,31 B type 9 cases,31 C type 4 cases;The intraoperative indicators(operative time,intraoperative blood loss,reduction),postoperative indicators(length of hospital stay,pain VAS score,healing time)and knee joint function indicators(KSS functional score at the last follow-up,knee joint range of motion,whether combined with anterior knee pain)of the two groups were observed and compared.Results: All patients successfully completed the surgical treatment,there were 39 cases lost to follow-up,and finally 53 patients completed the follow-up.A total of 5 patients used plot screws during the operation,including 3 cases in the antegrade intramedullary nail group and 2 cases in the retrograde intramedullary nail group;There were 7 complications in the antegrade intramedullary nail group and 3 complications in the retrograde intramedullary nail group.The difference was not statistically significant(P<0.05);The operation time of the anterograde intramedullary nailing group was(72.67± 9.26)min,longer than that of the retrograde intramedullary nailing group(58.70±8.42) min.The intraoperative blood loss(232.17±30.50)ml was higher than that of the retrograde group(207.17±23.25)ml,and the difference was statistically significant(P < 0.05).The comparison of postoperative indexes and knee function indexes between the two groups showed no statistical difference(P > 0.05).Conclusion: For the Infra-isthmal femoral shaft fracture,antegrade intramedullary nails and retrograde nails are both good fixation options under current operations,and Retrograde nails offers an adventage of short operation time,and less blood loss.