Anterior clamp-assisted reduction for retrograde nailing of infra-isthmic femoral fractures: technique and preliminary results on a short case series
Abstract
Infra-isthmal femoral fractures in elderly patients are difficult to stabilize due to the broad metaphyseal anatomy. In the absence of consensus on optimal management, this study assesses a minimally invasive technique combining anterior clamp-assisted reduction with retrograde intramedullary nailing. A retrospective case series was conducted on ten patients treated between January 2023 and April 2024. All underwent percutaneous fracture reduction via a limited anterior approach, followed by retrograde nailing. The mean patient age was 84.9 ± 6.2 years. All fractures were caused by low-energy trauma. Six involved native bone and four were periprosthetic. All cases progressed to union without infection or wound complications. One peri-implant fracture occurred at the proximal tip of the nail and was successfully treated with overlapping plate fixation. This technique was safe and effective for infra-isthmal spiral femoral fractures in elderly, frail patients. It allowed accurate reduction, minimized soft tissue disruption, and resulted in reliable fracture healing.
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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