CLOSED LOCKED NAILING OF COMPLEX FEMORAL FRACTURES

Complex fractures of the femoral shaft rise problems due to high energ y trauma with major soft-tissues injuries and bone comminution so incr easing operative difficulties, risk of infection and delayed union. Ou r aim was to apraise the outcome of these problems when using a closed intramedullary locked nailling.There were 52 men and 16 women. Aged 1 6 to 83 years. 52 patients had multiple-injuries. There were 17 open f ractures. The 68 cases were subdivided according to a classification i n 3 types. Stable fractures type A and B1 were excluded. The shaft was divided into 5 zones. Patients were initially treated by skeletal tra ction closed nailing was performed 1-36 days later (average 9.5). All patients were reviewed until complete healing. Final follow-up was 6 t o 35 months postoperatively (average 15). A dynamisation was performed in 19 cases at a average delay of 12 weeks. Sixty six of the 68 fract ures united. Open fractures united after 26.4 weeks, in average and cl osed fractures after 23.25 weeks (p <.05). There was no correlation be tween time of surgery following the injury and the delay of healing. S hortening was noted in 4 cases. 8 patients had an angulation 5-15 degr ees of in the varus or the valgus plane. 3 patients (4.4 per cent) had more than 5 degrees of angulation in the AP plane. An external rotati on deformity of 10-35 degrees was noted in 4 patients. The incidence o f deformities was the main problem. It could be minimize by a precise technique. Mobility of the knee was the other problem, but it appeared generally to depend much more on knee injury than on femoral fracture .