Retrograde Rodding Has Been Around for Years: Why are You Changing? - PowerPoint PPT Presentation

Retrograde Rodding Has Been Around for Years: Why are You Changing? I Get Results! Lisa K. Cannada, MD

Disclosures • No pertinent disclosures • Member: – AAOS Board of Directors – MAOA Board of Directors – OTA Committee Member

Ortho Jeopardy

Femur Fractures for $1000

The Answer: What is Retrograde Nailing?

While Others May be Struggling…

You Are Almost Done!

What is the role of retrograde nails in management of femur fractures today? Answer: Any and All!

INDICATIONS

Retrograde Nailing Bilateral Femur Fractures The Floating Knee

Retrograde Nailing Ipsilateral femoral neck fracture Ipsilateral operative pelvic or acetabular trauma

Retrograde Nailing Soft tissue trauma near insertion of antegrade nail Morbid Obesity

Retrograde Nailing Multiple trauma Severe trauma

Retrograde Nailing Preexisting hardware Need for increased distal fixation points

TECHNIQUE

Pre-Op Planning • Radiographic Evaluation • Fracture pattern amenable • Devise a plan to determine length and rotation

Positioning • Supine on table • Hip and knee draped free • Triangle or bolster under knee • Anesthesia help

Surgical Approach • Medial parapatellar or tendon splitting approach

Makes Your Case!

Another Reduction Aid

And if you Did Antergrade: Still Struggling…

COMPLICATIONS

Missed Femoral Neck Fractures: Much Worse if Antegrade • Treatment depends on timing of discovery • Adequate visualization BEFORE& AFTER case • Happens with both retrograde & antegrade

Dr. Zura: “It” Hurts

MYTHBUSTERS

YOU CAN’T RGN AN OPEN FEMUR FRACTURE

Conclusions/Myth Busted Relatively Low Rate of Knee Sepsis

YOU CAN’T RGN A GSW FEMUR FRACTURE

Conclusions/Myth Busted Relatively low incidence complications and deformity

WHAT ABOUT THE MISSED FEMORAL NECK FRACTURE?

Conclusions/Myth Busted No significant difference in missed FNF, but trend towards more missed…Always look!

YOU CAN’T RGN PROXIMAL FEMUR FRACTURES

Conclusions/Myth Busted Relatively low incidence complications and deformity

Conclusion • No significant difference in healing rate, op time, complications • Acceptable form of treatment for femoral shaft fractures

Even a Movie for This…

Thank You! Lcannada@slu.edu