UNREAMED INTRAMEDULLARY NAILING OF FEMORAL-SHAFT FRACTURES - OPERATIVE TECHNIQUE AND EARLY CLINICAL-EXPERIENCE WITH THE STANDARD LOCKING OPTION

Nailing techniques have changed in recent years in ways which are not just limited to omitting the reaming process. These changes concern po sitioning patients, techniques of reduction and selecting implants. Te chniques of approach and exposure have been modified to new, less-inva sive procedures to fulfill technical, functional and cosmetic requirem ents. In addition, techniques have been developed to avoid fragment di astasis, rotational and sagittal malalignment, and leg-length discrepa ncy. Finally simple algorithms have been elaborated for the management of specific fracture patterns (bilateral shaft fractures, ipsilateral tibial fractures or associated femoral neck fractures) and to determi ne the number and location of locking bolts. We developed these algori thms, techniques and procedures in a series of 133 femoral shafts, whi ch were stabilized with the AO unreamed femoral nail (URFN) in a prosp ective study between 1991 and 1994. Of these, the first 57 cases with a mean follow-up of 17.9 months (range, 5-44) after injury were review ed. Fractures were classified according to Muller's 1990 system: 12 ty pe A, 29 type B and 16 type C. Closed soft-tissue injuries were classi fied by our classification of 1982: 17 type C O/I, 42 type C II. Of 15 open fractures, six were OI, six OII, two OIIIA and one was OIIIB by Gustilo's classification of 1984. The major complications were two bro ken locking bolts, one nail breaking after 9 weeks, one case of osteit is and one of intra-operative lung embolism. (C) 1996 Published by Els evier Science Ltd.