Er. Hammacher et al., IMPROVED RESULTS IN TREATMENT OF FEMORAL-SHAFT FRACTURES WITH THE UNREAMED FEMORAL NAIL - A MULTICENTER EXPERIENCE, The journal of trauma, injury, infection, and critical care, 45(3), 1998, pp. 517-521
Objectives: The first studies of intramedullary nailing with the Arbei
dsgemeinschaft fur Osteosynthesefragen (AO) unreamed femoral nail in s
elected clinics showed favorable results. Daily practice, however, is
that femoral fractures are treated in a variety of clinics by a mixtur
e of surgeons, To evaluate whether similar results could be obtained i
n general practice, a prospective multicenter trial was undertaken, in
volving a variety of university and general hospitals in one country,
Methods: Between August of 1994 and June of 1996, 122 patients with 12
9 traumatic femoral shaft fractures treated with the unreamed femoral
nail in eight hospitals were included in this study. Patients who had
a reoperation with an unreamed femoral nail or patients with a patholo
gic fracture of the femur were excluded from this part of the study. O
f these patients, 58 patients had multiple injuries, and 33 of the fra
ctures had open soft-tissue injury. Results: Postoperative infection o
ccurred in four patients; the nail broke in one patient. In total, nin
e patients (6.6%) sustained general complications, five of which devel
oped adult respiratory distress syndrome (3.6%), Non-union occurred in
seven patients (5.1%) and delayed union occurred in four cases (2.9%)
with a reintervention rate of 6.6%, Conclusion: In this study, a decr
ease in the number of patients who develop adult respiratory distress
syndrome through the use of a thin unreamed nail could not be demonstr
ated. The promising early callus formation and good consolidation ment
ioned in previous studies could not be confirmed. We find that the tec
hnical and clinical results in this study of unreamed femoral nailing
in a mixture of clinics and by a variety of surgeons are comparable to
the results of reamed nailing in the literature and are not as favora
ble as in the previous reports.