Endosteal Substitution With an Intramedullary Rod in Fractures of the Femur.

Academic Article


  • BACKGROUND: Morbid obesity and segmental fracture/bone loss are challenging problems in the treatment of fractures and nonunions of the distal femur. The use of an intramedullary rod as an endosteal substitute for a deficient medial cortex along with a lateral locked plate is 1-tool to combat these problems. This article describes the technique used and its results at a single Level 1 trauma center. METHODS: Retrospective chart and radiographic review of all patients treated for acute fractures and nonunions of the distal femur using endosteal substitution with an intramedullary nail and a lateral locked plate. Fixation construct was determined at the surgeon's discretion and was strongly influenced by bone loss and patient body habitus. RESULTS: Seven of 8 acute fractures and 8 of 8 nonunions healed without an unplanned reoperation. There were no cases of secondary displacement after fixation, and only 1 unplanned reoperation in the study group. CONCLUSION: Endosteal substitution with an intramedullary rod and the use of a lateral locked plate provides the stability needed to allow bone healing under prolonged or supraphysiologic loads seen in morbid obesity or segmental bone loss. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
  • Authors

    Published In


  • Adult, Aged, Bone Plates, Bone Screws, Databases, Factual, Female, Femoral Fractures, Follow-Up Studies, Fracture Fixation, Internal, Fracture Fixation, Intramedullary, Fracture Healing, Fractures, Ununited, Humans, Injury Severity Score, Male, Middle Aged, Retrospective Studies, Trauma Centers, Treatment Outcome, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Spitler CA; Bergin PF; Russell GV; Graves ML
  • Start Page

  • S25
  • End Page

  • S29
  • Volume

  • 32 Suppl 1