Twenty-seven patients with 28 open femoral shaft fractures were treate
d by intramedullary nailing, Ten fractures were Grade I, nine Grade II
and nine Grade III according to Gustilo. After debridement and irriga
tion of the wounds, 26 fractures were nailed immediately, whilst two f
ractures were stabilized at an early stage. Two infections developed.
One occurred before intramedullary nailing during a period of femoral
traction. Both infections were treated successfully. The authors concl
ude that primary intramedullary nailing is safe in open femoral fractu
res of all grades. If a thorough debridement and irrigation are perfor
med, the postoperative infection rate is low.