The treatment of difficult proximal femoral fractures with the Russell-Taylor reconstruction nail

The outcome of 30 proximal femoral fractures and pathological lesions in 29 patients treated with the Russell-Taylor reconstruction nail are reported. Four patients had fractures involving both the femoral neck and shaft (seg mental). Fifteen patients had extensive comminuted fractures of the proxima l femur and ten patients underwent nailing because of pathological fracture s (one bilateral). In nineteen operations there were technical difficulties, nail insertion an d proximal interlocking being the commonest. In the elderly there was a hig h post-operative complication rate. Three nails needed to be revised for fa ilure of fixation. On review, all patients under sixty years of age regaine d full mobility and returned to their pre-fracture level of activities. Pat ients with per-trochanteric fractures over the age of sixty had less favour able results. No cancer patient returned to their prefracture mobility leve l. The Russell-Taylor reconstruction nail proved to be useful in the treatment of segmented and, in a lesser degree, pathological fractures. However, the surgical technique is demanding and there is a high incidence of post-oper ative complications in the patients over the age of sixty. (C) 1999 Elsevie r Science Ltd. All rights reserved.