Abstract:

Background: Retrograde nailing represents an established fixation method for fixation of the femoral fractures and offers an alternative to the existing technique of antegrade nailing. However; it is considered to affect the range of motion and create persistent pain to the knee joints, because of theoretical problems encountered during its insertion through the intercondylar notch. Little is known on the effects of retrograde nailing on the knee functional outcomes among patients treated at our setting.

Aim of the study: This study was conducted to assess the short-term knee functional outcomes following retrograde femoral nailing and further evaluated the association between the influencing factors and the knee range of motion and pain.

Methodology: The study was an analytical cross-sectional, conducted after the approval from the BMC-Clinical Research and Ethical Committee. A consecutive sampling technique was used to recruit patients who attained 12 weeks follow up at outpatient and physiotherapy clinics following retrograde nailing of femur fractures. Structured questionnaires were used to gather patients’ information and visual analogue score (VAS) and Thoresen score tools were used to assess pain and range of motion respectively. Chi-square test and Fisher exact test were used to predict the association between independent and dependent variables and p-value<0.05 was considered statistically significant. Continuous variables were expressed in terms of mean and standard deviation (SD) and categorical variables in terms of frequency and percentages. Results were presented by using tables and charts.

Results: 97 patients who underwent retrograde nailing and attained 12 weeks follow up were included into this study with the mean age of 38.11±17.161 ranging from 15-83 years with male predominance (2.1:1). 59 patients (60.8%) reported a history of mild to no pain at twelve weeks by using VAS score and fewer complained of moderate to severe pain. Furthermore; majority of the patients [n=69(71.1%)] were able to achieve a knee flexion of more than 90 degrees which fall under the category of good to excellent range of motion by using Thoresen criteria. Advanced age (>45 years) and distal femur fractures (AO type 33) were statistically significant associated with occurrence of knee pain (p<0.05) post fixation. Also, young age was the only independent factor that influenced the knee range of motion (knee flexion>90 degree).

Conclusion and Recommendation: Findings from this study showed that; advanced age of the patients (>45 years) and distal femur fractures (AO type 33) were statistically significant associated with occurrence of moderate to severe pain at 12 weeks following retrograde nailing. Furthermore, young age of the patients (<31 years), was the only independent factor to be associated with moderate to excellent knee range of motion. However; I recommend another study with large sample size and follow up component to be carried out to ascertain clear association between the mentioned influencing factors and the knee pain and range of motion.