Interlocking Intramedullary Nailing for femoral Shaft Fracture: Closed and Open Nailings

Chang, Ju Hai; Sohn, Jong Min; An, Dong Reon; Kim, Sung Tae

Abstract

Femoral shaft fractures are caused by violent external forces like motor vehicle or falling down accident and associated with multiple injuries of other parts of the body, so that accurate reduction and rigid fixation is mandatory to ensure early fracture healing and mobilization of patients. Authors thought that the interlocking intramedullary nailing may be one of methods that can provide rigid and stable fixation for the unstable fracture of femoral shaft. Thus this study was carried out to assess the effectiveness of open reduction and interlocking intramedullary nailing to the comminuted unstable femoral shaft fracture. Twenty-seven femoral shaft fractures were treated by closed or open interlocking intramedullary nailing from July 1990 through August 1994 and followed-up at least for 12 months. Closed nailings were 11 and open nailings were 16 cases. Radiological union was obtained at an average of 15 weeks in closed nailing cases and at an average of 21 weeks in open nailing cases. However, comparative anlysis of union times was meaningless because of different fracture patterns in both open and closed nailings. Clinical results by Thoresens classification were excellent in all cases. Complications were 3 iatrogenic cortical fractures developed by closed nailing procedures and 3 deep infections, one after closed nailing and two after open nailing. There was no sequela related directly to the intramedullary nailing. Authors thought is that open intramedullary nailing is beneficial to the unstable comminuted fracture of femoral shaft in spite of increasing risk of infection, because that permits accurate reduction and secure fixation of the comminuted fragments and sometimes bone grafting with compatible clinical results.