Reamed intramedullary nailing of the femur: 551 cases

Background: The care of the patient with the fractured femur entails a mult iple surgical team approach. Healing of the fracture and expediency in the operating room are both important. We sought to determine the results of th e treatment of fractures of the femoral shaft with interlocking femoral nai ls inserted with closed techniques, and to compare the outcomes of fracture s nailed by using a fracture table with those stabilized with the leg drape d free on a radiolucent table. Methods: Eight hundred eighty-two consecutive patients with fractures of th e femoral shaft treated with a first-generation intramedullary nail at the authors' institution during the Sears 1986 to 1996 were identified. Five hu ndred fifty-one fractures in 515 patients met the inclusion criteria. Results: Treatment with an intramedullary nail led to a union rate of 98.9% , There were six infections, all occurring in closed fractures. Thirty-eigh t percent of the fractures had hardware removed, mast commonly because of p ain. One nail and 13 locking bolts broke. Pour hundred eighteen fractures h ad adequate radiographs available to assess fracture alignment. No fracture healed with more than 10 degrees of angulation in either plane, Forty-four fractures healed with more than 5 degrees of angulation. A distal third fr acture was found to be associated with an increased incidence of malalignme nt. There were no differences in outcomes between fractures stabilized with or without a fracture table, Conclusion: Reamed intramedullary nailing of femoral shaft fractures result s in a low rate of nonunion, malunion, infection, and hardware failure. The re is no difference in the outcomes of fractures treated with and without t he use of a fracture table. This is particularly useful in the patient with multiple injuries for whom transfer to a fracture table may not be time ef fective.