الفهرس 
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Abstract
The study was a prospective comparative study that conducted on
40 patients with diaphyseal femur fractures in adults. This study was
conducted in Menoufia University Hospitals. The study was conducted
from December 2017 till April 2021. All patients managed by closed
reduction and internal fixation by retrograde or antegrade intramedullary
nailing.
They were divided randomly into two equal groups:
group A included 18 males and 2 females with mean age 25.10±10.41
(range 16 - 60 years) had diaphyseal femur fractures fixed by antegrade IMN.
Mean body mass index was (range 17.4-35.6 ). Antegrade approach involved
making a skin incision at the level of the greater trochanter extending proximal for
5cm. The piriformis entry point was used in all antegrade femoral nailing.
Reduction was performed under image intensification by traction and counter
traction. Then, a guide wire was advanced into the proximal fragment to the distal
fragment. The reaming was performed in sequential steps with increments of 0.5
mm each. The nail was inserted manually. The correct position of the nail and the
rotation of the femur were verified to reach anatomical reduction. Distal locking
was inserted first before proximal locking. Finally the fascia and the skin were
closed as separate layers. Operating time in antegrade nailing technique was
58.75±11.11 ( range from 40-75 min). Mean duration of follow up was
25.20±8.39 months (range 12 - 36 months).
group B included 17 males and 3 females with mean age was 31.35±10.11
(range 20 – 57 years) had diaphyseal femur fractures fixed by retrograde IMN.).
Mean body mass index was (range 18-34.2). Operating time in retrograde nailing
technique was 73.00±14.18 ( range from 55-105 min). Retrograde approach
involved making 5-7 cm para-patellar longitudinal incision in 14 patients and 3-5
cm trans-patellar tendon longitudinal incision in 6 patients. The infra-patella fat
pad either excised or swept aside to expose the femoral intercondylar notch. [10]
The entry point was centered in intercondylar area anterior to Blumensaat line in
lateral view under image intensifier. Reduction was performed under imaging by
traction and counter traction. Then, a guide wire was advanced into the distal