A LOCKED HIP SCREW INTRAMEDULLARY NAIL (CEPHALOMEDULLARY NAIL) FOR THE TREATMENT OF FRACTURES OF THE PROXIMAL PART OF THE FEMUR COMBINED WITH FRACTURES OF THE FEMORAL-SHAFT

Twenty-seven patients with complex femoral fractures (combined shaft a nd proximal femoral fractures) were treated with a modified Grosse-Kem pf slotted locking nail (cephalomedullary nail), wherein two screws we re inserted in the hip. Four types of complex, multifocal femoral frac tures were represented in the series. Eleven of the femoral shaft frac tures were secondary to a previous, internally fixed, not yet united h ip fracture (type I). Ten comminuted peritrochanteric fractures occurr ed in normal bone (type II). Three similar fractures were pathologic b ecause of metastasis. Two patients had an ipsilateral fracture of the femoral shaft and the trochanteric area (type III), and one of the sha ft and the femoral neck (type IV), Locking was made static in 24 cases . Additional cerclage wiring was used in three type II fractures. Five complications were as follows: one cutting out of a screw in the femo ral head, two fractures of the nail, one deep venous thrombosis, and o ne wound hematoma. Reoperations were two salvage operations using a ne re nail and one evacuation of hematoma. One patient with multiple inj uries and four elderly patients died within 2 months. Eighteen patient s with fractures in normal bone were followed for a median of 20 (6 to 37) months. All fractures united. Two nails were removed. The end res ult was excellent in ten patients, good in seven, and fair in one (2-c m shortening and 20-degree external rotation). We conclude that a lock ed intramedullary construct with locking screws in femoral neck and di stal femur controls a complex fracture situation well.