I would make a strong argument that lateral soft tissue dissection for plate placement (especially since debridement of open fracture is necessary anyway) is much less damaging to the articular surface than a retrograde nail.
Also, even though antegrade nailing is possible, all the discussion about using Ilizarov wires, rings and/or arcs takes this method from the realm of straightforward to the complex IMHO.
I think retrograde IM nail is a good option, but one needs to be sure that the fracture is out to length with this comminuted metaphysis.
I have used 95 degree blade plates, condylar screws w/ side plate, supracondylar nails, long retrograde IM nails and now, more recently the locking anatomic plates. The locking plate technology is a big step forward in my hands to achieve better reduction and more stable fixation
while preserving blood supply in these fractures.
Terry I. Finlayson, M.D.
Logan, UT USA
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