Open Access
Review
Table 3
Qualitative data (Retrograde vs Antegrade).
| Author | Fractture type | Number of each fracture type | Cause of refracture | Reason for reoperation | Reported complications |
|---|---|---|---|---|---|
| Adesina et al. [18] | Diaphyseal femur fractures (AO/OTA type 32A, 32B, 32C) | 32-A: Retrograde 63; Antegrade 43; Total 106 32-B: Retrograde 69; Antegrade 33; Total 102 32-C: Retrograde 22; Antegrade 8; Total 30 |
NR | NR | Antegrade – Infection – 1 Retrogarde Infection – 2 |
| Gönder et al. [19] | Extra-articular distal femur fractures (AO/OTA 33A2–33A3) and distal femoral shaft fractures (AO/OTA 32A1c, 32A2c, 32A3c, 32B2c, 32B3c) including distal diaphyseal–metaphyseal fractures (32C3k). | 33A2: Retrograde 19; Antegrade 11 33A3: Retrograde 13; Antegrade 4 32A1c: Retrograde 2; Antegrade 5 32A2c: Retrograde 3; Antegrade 1 32A3c: Retrograde 1; Antegrade 3 32B2c: Retrograde 3; Antegrade 7 32B3c: Retrograde 5; Antegrade 4 32C3k: Retrograde 2; Antegrade 1 |
NR | NR | Antegrade – Implant failure = 0 Non-union = 1 Infection = 4 Retrograde Implant failure = 3 Non-union = 2 Infection = 4 |
| Ricci et al. [20] | Femoral diaphyseal shaft fractures. Categorized by location (proximal/middle/distal), open vs closed injury, degree of comminution (Winquist I–IV), and OTA types (32A–C). | Proximal one third: 31 total (10 in Group R; 21 in Group A).Middle one third: 111 total (52 in Group R; 59 in Group A).Distal one third: 56 total (42 in Group R; 14 in Group A). Closed: 154 total (80 in Group R; 74 in Group A). Open: 44 total (24 in Group R; 20 in Group A). Winquist Type I: 38 (Group R), 41 (Group A. Winquist Type II: 23 (Group R), 15 (Group A). Winquist Type III: 26 (Group R), 20 (Group A). Winquist Type IV: 17 (Group R), 18 (Group A). OTA Type 32A: 38 (Group R), 42 (Group A). OTA Type 32B: 51 (Group R), 34 (Group A). OTA Type 32C: 15 (Group R), 18 (Group A). | Antegrade – 0 Retrograde nailing – 3 Refractures. (1 – nail fracture, 1 – ipsilateral coronal fracture of medial femoral condyle after knee arthroscopy treated with ORIF, 1 – ipsilateral patella fracture). |
Antegrade nailing – 22 – in total. 16 for mechanical / hardware issues. 6 additional revision procedures for delayed union/nonunion. (5 – Removal of painful interlocking screws, 4 – nail revision for shortening, 4 – nail removals, 1 – exchange of loose interlocking screw, 1 – revision of bent nail, 1 – removal of exostosis, 1 – dynamization for delayed union, 5 – exchange nail reoperations for nonunion). Retrograde nailing – 26 – in total 17 for mechanical or knee-related issues. 9 additional revision procedures for delayed/nonunion. (6 – Removal of painful interlocking screws, 4 – knee arthroscopy, 2 – knee manipulations, 1 – rotational malalignment, 1 – nail fracture, 1 – nail removal after migration to knee, 1 – removal of heterotopic bone from post-patellar region, 1 – aborted retrograde nailing and revised with antegrade nailing, 5 – exchange nail reoperations for nonunion, 3 – dynamizations for delayed union, 1 – dynamization for nonunion). |
Antegrade Knee pain – 11 (12%) Hip pain – 10 (10%) Fractured interlocking screws – 4 (4%) Bent nail – 1 Heterotopic ossification – 24 (26%) Pulmonary embolism – 2 (2%) Fat embolus syndrome – 1 (1%) Deep venous thrombosis – 1 (1%) Transient pudendal nerve palsy – 1 (1%) 84 Unions – 89% 4 Delayed unions – 4% 12 Malunions – 13% 6 Nonunions – 6% 93 Unions after revisions – 99% Retrograde: - Knee pain – 34 (33%) Hip pain – 3 (4%) Fractured interlocking screws – 9 (9%) Nail Migration into knee joint – 2 Nail Fracture – 1 Heterotopic ossification – 1 Rotational Malalignment – 1 91 Unions – 88% 7 Delayed unions – 7% 11 Malunions – 11% 6 Nonunions – 6% 101 Unions after revisions – 97% |
| Chan et al. [21] | Femoral diaphyseal shaft fractures. Categorized by location (proximal/middle/distal), open vs closed injury, and degree of comminution (Winquist I–IV). | Proximal: 13 (Antegrade), 0 (Retrograde). Middle: 25 (Antegrade), 10 (Retrograde). Distal: 4 (Antegrade), 24 (Retrograde). Closed: 36 (Antegrade), 30 (Retrograde). Open (Grade 1 & 2): 5 (Antegrade), 4 (Retrograde). Open (Grade 3): 1 (Antegrade), 0 (Retrograde). Winquist Type 1: 16 (Antegrade), 21 (Retrograde). Winquist Type 2: 6 (Antegrade), 7 (Retrograde). Winquist Type 3: 7 (Antegrade), 5 (Retrograde). Winquist Type 4: 13 (Antegrade), 1 (Retrograde). |
Antegrade – 0 Retrograde – 0 |
Antegrade – 0 Retrograde – 0 |
Antegrade Knee pain – 9.5% of patients. Implant Infection – 1 case. Implant failure – 3 cases. Malalignment – 2 – 4 cases. 36 Unions – 85.7% 4 Delayed Unions – 9.5% 2 Nonunions - 4.8% Malunion – not significant 42 Unions after revisions – 100% Retrograde Knee pain – 2.9% of patients. Union – 100% – in all 35 cases |
| Bogl et al. [22] | low-energy femoral shaft (diaphyseal) fractures and subtrochanteric fractures (proximal metaphyseal/transition zone fractures). | Diaphyseal (Shaft): 134 (Femoral Neck Protection), 248 (No Protection). Subtrochanteric: 506 (Femoral Neck Protection), 9 (No Protection). | Antegrade – 0 Retrograde -: 14 proximal peri-implant hip fractures |
Antegrade – 27 major (implant revision/removal/arthroplasty) + 19 minor (hardware/wound revision) Retrograde – 24 major (implant revision/removal/arthroplasty) + 12 minor (hardware/wound revision) |
Antegrade 7 distal peri implant fractures, no proximal fractures or avascular necrosis reported Retrograde 14 proximal peri implant hip fractures and no avascular necrosis reported |
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