Pitfalls and Complications in the Use of Interlocking Intramedullary Nailing for the Femoral Fractures

Hwang, Sung Kwan; Yoon, Jong Seon

Abstract

The introduction of percutaneously inserted transfixing interlocking screws increase the stabization potential of the intramedullary nail. The use of interlocking system extend the indications for closed intramedullary nailing. However, the added technical complexity, related with the locking screws, introduces a new errors and pitfalls. Among 32 patients who had closed interlocking I.M. nailing for 32 femoral fractures, 7 patients showed intra-or-postoperative complications. Six patients had intraoperative complication : four patients(new fracture near the fracture site) ; one patient(femur neck fracture), and one patient(failure of distal locking). Two patients experienced postoperative complication :one deep infection and another, proximal migration of nail. All 7 patients had pitfalls and complications related with operative techniques for interlocking I.M nailing. After careful analysis of the pitfalls and complications, following suggestions were considered. 1. To reduce the new fracture near the fracture site, insert the nail through an entry portal of trochanteric fossa centered over the axis of the femoral medullary canal. 3. Avoid repeated awling and placing the entry portal too far medially, which can result in iatorogenic fracture of the femur neck. 4. After distal screw insertion, the correct position of the screw in the screw hole should be confirmed on AP and lateral view. 5. Adequate preoperative and postoperative use of antibiotics were seriously considered in case of open fractures.