Segmental Fractures of the Femur Treated by Intramedullary Nailing

Kim, Ki Tack; Chung, Duke Whan; Bae, Sang Wook; Kim, Bong Kun

Abstract

Since the segmental fractures of the femur are resulted by violent force, they are frequently associated with severe soft tissue damage and multiple skelectal injuries and they necessitated careful emergency care. Occasionally, they combined with severe communition, so their ultimate fixation of the fractures are very difficult. Authors analysed sixteen fractures of the segmental fracture of the femur which were treated by intramedullary nailing with or without interlocking at the Kyung Hee University, medical college, from the December, 1975 to May, 1985. In eight of sixteen cases the nailing was done by closed technique, one case was semiclosed. In the seven fractures the traditional retrograde nailing technique with open reduction of fracture was used. The pin & plaster, cast brace, side bone plate, wiring or interlocking screws were used as additional stabilization to intramedullary nailing. The diameter of the nails were 9-12 mm in 5 cases, 13-15 mm in 11 cases. There were no need the cancellous bone graft to promote the bony union. The results were as follows; 1. The closed intramedullary nailing with interlocking screw offers an ideal anatomical, functional and physiological treatment for the segmental fracture of the femur. 2. When the segmental fracture of the femur involves the neck or supra- or intercondylar fractures, the intramedullary nailing can be used with Knowles pin or tibial bolt fixation. 3. In the cases of infected nonunion, we obtained solid bony union by means of extensive and meticulous debridement and rigid intramedullary nailing using additional devices without cancellous bone graft.