Management of distal femoral fractures in elderly patients using retrograde titanium supracondylar nails A. Kumar*, V. Jasani, M.S. Butt Department of Trauma & Orthopaedics, Russells Hall Hospital, Dudley, West Midlands, UK Accepted 18 October 1999 Abstract We present our experience with a retrograde supracondylar nail used for the management of fractures of the distal femur in elderly patients. Eighteen fractures of the distal femur in 18 patients were treated with AIM titanium supracondylar nails. Sixteen patients with a median age of 83 years (62±100 years) were ®nally available for review. All 16 fractures were classi®ed as extra-articular type A according to the AO classi®cation. The average operative time was 58 min. Follow up ranged between 4 and 35 months (average 20.4 months). Fifteen fractures (93.7%) united in an average duration of 3.6 months. The average range of motion achieved at the knee was 100.68. There were no implant failures, knee sepsis or wound healing problems. One non- union and two stress fractures of the femur above the nail were the main complications in this series. We concluded that the AIM titanium supracondylar nail is a useful alternative implant for the management of the osteoporotic fractures of the distal femur particularly the extra-articular AO type A fracture in the elderly population. # 2000 Elsevier Science Ltd. All rights reserved. 1. Introduction Fractures of the distal femur in the elderly popu- lation are dicult to treat because of osteopenia and preexisting hip and knee disabilities which can also predispose to these fractures [1]. Stewart et al. and Neer et al. recommended conservative management because of the possibility of infection and inadequate ®xation [2,3]. However, with improvement in tech- niques and instrumentation, surgical treatment has been recommended to reduce the period of immobilis- ation and morbidity [4]. Rigid internal ®xation of osteoporotic fractures in elderly patients is dicult because of degree of comminution and poor bone stock [5±7]. The antegrade nailing can be technically dicult in an arthritic and sti hip and can not be used in the presence of other implants in the proximal femur. Recently retrograde nailing has gained popular- ity in the management of these fractures for distinct advantages of preservation of the fracture haematoma, decreased blood loss, minimal soft tissue dissection, less operative time and reduced rate of infection [8± 12]. Satisfactory results have been reported in elderly patients after using an interlocking retrograde supra- condylar nail [10±12] and Zickel supracondylar nail [13] for distal femoral fractures. We present our results of using the AIM titanium supracondylar nail in the management of distal femoral fractures in elderly patients. 2. Materials and methods Eighteen fractures of the distal femur in 18 patients were treated with the AIM titanium supracondylar nail (DePuy ACE) between July 1995 and April 1998. One patient died due to medical reasons before ade- quate post-operative follow up was completed; another patient failed to attend the clinic for ®nal assessment being asymptomatic, leaving 16 patients for ®nal Injury, Int. J. Care Injured 31 (2000) 169±173 0020-1383/00/$ - see front matter # 2000 Elsevier Science Ltd. All rights reserved. PII: S0020-1383(99)00275-2 www.elsevier.com/locate/injury * Corresponding author. 51, Heberdeen Park, London N5 2AZ, UK. Tel.: +44-1902-307-999; fax: +44-1902-642-833.