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A Single Proximal Interlocking Bolt May Be Sufficient for Retrograde Nailing of Extra-articular Femur Fractures

Objective: To evaluate whether a single proximal interlocking bolt was sufficient during the treatment of extra-articular femur fractures with retrograde medullary nailing. Design: Retrospective comparative study. Setting: Academic Level 1 trauma center. Patients: The study included 136 patients with extra-articular femur fractures treated with retrograde medullary nailing who met inclusion and follow-up criteria. Intervention: The intervention included surgical treatment for a femur fracture with retrograde medullary nailing, with comparisons made between those treated with a single proximal interlocking (1 IL) bolt and those treated with 2 proximal interlocking bolts (2 IL). Main Outcome Measurement: The main outcome measurements were as follows: (1) rate of nonunion and (2) rate of catastrophic implant failure. Results: There was no difference in the rate of nonunion requiring surgical intervention between the 2 groups. There were no catastrophic failures in either group. Conclusions: A single proximal interlocking bolt may be sufficient when using retrograde nailing for the treatment of extra-articular femur fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.