LOCAL COMPLICATIONS OF INTRAMEDULLARY NAI LING

In the period from January 1990 to the end of December 1995 intramedul lary nailing was performed in 294 patients with 156 fractures of the f emur and 162 fractures of the tibia. Early nailing within the first 24 h after trauma was realized in 70 % of the femur and in 64 % of the t ibia fractures. A synopsis focusing on local complications after intra medullary nailing is given on the basis of our results and a thorough analysis of the literature. Iatrogenous fractures of the femoral neck (0-5 %), of the proximal femur (0.8-11.2 %) and of the tibial head (0- 8.3 %) represent important intraoperative complications. Less frequent , but even more serious, are intraoperative lesions of nerves and arte ries, as well as the development of compartmental syndromes of the low er leg (0-8.6%). Lengthy procedures and the use of traction tables see m to foster those complications. After primary intramedullary nailing, non-unions of the femur can be expected in 1-2 % and of the tibia in 2-4 %. The corresponding rates of osteomyelitis are 1-1.5% and 2-3%, r espectively. After secondary nailing, particularly when changing from external fixation, and in cases of open fractures, the risk of deep in fection is essentially elevated. Intramedullary nailing of the femur p resents an important tendancy to external torsional malalignment. In o ur investigation the torsional tolerance of 15 degrees was exceeded in 26 %. A corresponding postoperative shortening of more than 2 cm leng th difference can be expected in 1.7-9.8 %. Spiral fractures of the di stal tibia offer a critical tendancy to secondary varus and torsional malalignment, particularly after unreamed nailing and consecutive shor tening due to breakage of locking bolts. The therapeutic indications o f fracture stabilization in cases of unstable metaphysal fractures sho uld be reviewed.