INTRAMEDULLARY NAILING OF CLOSED FEMORAL FRACTURES

Intramedullary nailing of femoral fractures has gone through a revival in the past few years because of improvements in both materials and d esign. Axial forces are tolerated very well by the nail; however, its stiffness in both rotation and bending is related inversely to its wor king length. Fractures of the middle shaft can be stabilized without p roblems due to elastic contact forces that result in a tight grip insi de the bone. Reaming and interlocking extend the indications to more c omplicated fractures. The development of solid nails with augmented st iffness, but smaller diameter, permits unreamed nailing with reduced d amage to the medullary cavity and the avoidance of dead space. The AO developed a modular solid nail system with a variety of interlocking p ossibilities. With respect to soft tissue injury and biomechanics, nai ling is the procedure of choice for femoral fractures.