UNREAMED INTRAMEDULLARY NAILING OF FEMORAL FRACTURES

Seventy-five patients with 81 femoral shaft fractures were treated wit h unreamed antegrade intramedullary nailing using a titanium alloy imp lant (AIM femoral nail, ACE Medical) with static interlocking. There w ere 73 closed fractures and 8 open fractures. Six patients had bilater al femoral shaft fractures. In two cases there was an ipsilateral frac ture of the femoral neck, two patients had an ipsilateral intertrochan teric fracture, in one case there was a concomitant subtrochanteric fr acture, and four patients had sustained an ipsilateral fracture of the acetabulum in addition to their femoral shaft fractures. In 43 cases (53%) the fracture of the femoral shaft was a comminuted type fracture . Thirty-nine patients (52%) had suffered multiple injuries; the mean Injury Severity Score was 41.2. Sixty-nine fractures were stabilized p rimarily within 8 hours after admission and 12 fractures were treated secondarily, in a mean of 5.8 days after injury. Closed intramedullary nailing was performed in 73 femora and open nailing with cerclage wir ing was done in 8. All 81 nails were implanted unreamed and static was used in every case. The diameters of the nails used were 9 mm (n = 68 ) and 10 mm (n = 13). Proximal interlocking was distally directed in 7 6 cases and proximally directed in 5 cases. Two patients died of sever e head injuries and one patient died of multiple organ failure. The in fection rate was 0%, and uneventful consolidation of the fractures was seen in all cases within a mean of 3.8 months. Neither in the case of nails nor in the case of interlocking bolts did an implant failure oc cur.