Enclavado endomedular retrógrado en fracturas diafisarias de fémur: indicaciones, técnica y resultados

• Autores: Sebastian Pereira, Alfonso Lugones, Gabriel Vindver, Fernando Manuel Bidolegui
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 79, Nº. 4, 2014, págs. 210-217
• Idioma: español
• DOI: 10.15417/340
• Títulos paralelos:
  • Retrograde nailing for diaphyseal femoral fracture: indications, technique and outcomes
• Enlaces
  • Texto completo (pdf)
• Resumen
  • español

    In­tro­duc­ción: el enclavado endomedular fresado anterógrado es el método de elección para el tratamiento de las fracturas diafisarias de fémur. Sin embargo, la técnica retrógrada surgió como alternativa para situaciones en las que la técnica anterógrada tiene ciertas desventajas.Materiales ­y ­Métodos:­ entre marzo de 2001 y enero de 2011, se realizaron 110 enclavados retrógrados de fémur, 34 de ellos en pacientes con fracturas diafisarias de fémur. Los mecanismos de lesión fueron: colisión vehicular (15 casos), traumatismo de baja energía (18 casos) y proyectil de arma de fuego (1 caso). Once pacientes (31%) tenían lesiones asociadas.Resultados:­ treinta y tres pacientes consiguieron la consolidación ósea (97%). El tiempo medio de consolidación fue de 84 días para los clavos fresados y de 112 días para los no fresados. Hubo un caso de retraso de la consolidación. El rango de movilidad de la rodilla promedio fue de 130º de flexión (mínimo 100º y máximo 150º). Seis pacientes (17,6%) refirieron dolor de rodilla. Conclusiones:­ el clavo retrógrado para el tratamiento de fracturas diafisarias de fémur consigue resultados de consolidación similares a los del clavo anterógrado de fémur. Sus posibles ventajas son la técnica simple, un menor tiempo quirúrgico y la posibilidad de operar sin el uso de una mesa de tracción.  

  • English

    Background: the antegrade intramedullary reamed nailing is the method of choice for treating diaphyseal femoral fractures. Nevertheless, the retrograde technique has emerged as an alternative for situations in which the antegrade one presents certain disadvantages.Methods: between March 2001 and January 2011, 110 femoral retrograde nailings were performed. Thirty-four were performed in patients with diaphyseal femoral fractures. Mechanisms of injury were vehicular collision (15 cases), low energy trauma (18 cases) and ballistic trauma (1 case). Eleven patients (31%) presented associated injuries.Results: thirty-three patients achieved consolidation (97%). Healing after procedure occurred at 84 days for the reamed group and 112 for the undreamed one. We had one case of consolidation delay that was resolved inserting a larger diameter reamed nail together with autologous graft. The average range of motion was 130º of flexion (minimum 100º, maximum 150º). Six patients (17.6%) reported knee pain.Conclusions: the retrograde nailing for diaphyseal femoral fractures yields consolidation results similar to those of the antegrade nailing. The possible advantages are: simple technique, the avoidance of traction table use during surgery and shorter surgical time.  

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