The Marchetti bundle nail for femoral shaft fractures: a review of 56 cases.

The aim of this retrospective study of 56 cases was to determine the risks and the limits of the Marchetti bundle nail in the treatment of femoral shaft fractures. According to the AO classification, 25 fractures were in category A, 20 in category B, 7 in category C and 4 were distal metaphysio-diaphyseal fractures with intercondylar separation classified as 33C2. Intraoperative complications were not directly related to the type of nail. Postoperative complications included nonunion, delayed union, malunion such as axial deformity, and shortening. We conclude that the Marchetti bundle nail is a successful method for the treatment of femoral shaft fractures taking into consideration the short operation time, the efficacy of distal locking and the lack of preliminary reaming. Moreover, it is clear that our results were prejudiced due to our learning experience with this new implant. Proximal locking should only be carried out when indicated, in order to prevent delayed union. It may be combined with interfragmental screw fixation, and this is useful in the treatment of complex supracondylar fractures.

[Type II fractures]. / Les fractures du fémur de type II après prothèse de hanche.

Ninety-seven patients type II were in this study. There were 35 male and 53 female patient, whose average age at revision was 74,5 year old. In this group the average time to fracture after arthroplasty was 6,2 (1-20) years.The fracture was spiral in most cases (82%), but some there were transverse (18%). Loosening of the prosthesis often occured with the transverse fracture (p=0,001).Loosening occured in 30% cases before the femoral fracture : it was rarely a major, but its duration was unknown.Three different methods of treatment were used in this study: - conservative treatment was used rarely, where there was a surgical risk in incomplete or undisplaced fracture. Treatment with traction involved a prolonged stay in hospital (two months average). - internal fixation without removal of the prosthesis was used in 44% cases. Fixation with plates in 93%. Other devices were screw and cerclage wire fixation. - 47,5% cases were revised with a long stem cemented prosthesis. The most difficult was type II fracture associated with femoral loosening. The location of type II fracture may compromise the stability of prosthesis. Although there was 41% of cases whose prosthesis was not loose before fracture. In these cases, type II fracture has not compromised the stability of prosthesis: the spiral line could shape peri prosthetic mantle of cement.Healing of the fracture was obtained in most cases (97%). Thus, protetic loosening created by type II fracture has not prevented consolidation: these two events are statistically independant.The present retrospective study supports the employement of different treatment. Based on these findings, the following management of type II fracture could be recommended: - undisplaced or incomplete fracture in high risk patients, should be treated conservatively. If loosening of the prosthesis develops, revision of the arthroplasty can be done after fracture healing. - internal fixation without revision of the prosthesis should be employed if the prosthetic stem stability is not compromised. - revision of the arthroplasty should be done if loosening of the prosthesis developped before or during the type II fracture occured. Then, a long stem should be employed.