Interlocking intramedullary nailing assessment of its application to comminuted fractures of the femur

ABSTRACT

Twenty-six comminuted fractures of the shaft of the femur in twenty-four patients were treated with closed reamed interlocking intramedullary nailing.Seventeen fractures were closed [65.4%] and nine fractures were open [34.6%]. There were eighteen male patients and six female patients with an average age 32 years [range from 20 - 62 years]. The fractures were right sided in thirteen patients, left sided in nine patients, and bilateral in two patients. Fifteen fractures were type I and II comminution [61.6%]. Eleven fractures were severily comminuted [38.4%], type III and IV. The fractures involving the proximal and the distal thirds were classified as unstable fractures.Twenty-two [84.6%] of the fractures united at an average of five months without additional surgical intervention. All fractures were treated by static nailing and dynamization was not attempted due to the comminution present. The average time of follow up was eighteen months. There were four fractures with pseudoarthrosis [15.4%], three patients had shortening between 1-2 cm and two had lengthening between 1-2 cm .One patient only developed deep infection. Renailing was done in three patients.This study shown that closed medullary locked nailing could provide sufficient stability in comminuted fractures of the femoral shaft irrespective to the degree of comminution and the site of the injury. Through preservation of vascularization and soft tissue attachment, closed nailing could provide excellent bone healing capability. It might be the modality of choice in such type of fracture