Anterior clamp-assisted reduction for retrograde nailing of infra-isthmic femoral fractures: technique and preliminary results on a short case series

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.