A study on role of intramedullary interlocking nailing in the complex femoral shaft fractures
Keywords:Femur fracture, Interlocking nailing technique, Neurovascular damage, High-velocity injuries
Background: Fractures of the shaft of the femur are a major cause of morbidity and mortality in patients who sustain high energy trauma. Morbidity arises from limb shortening, malalignment, knee contractures and other complications of fracture.
Methods: The aim of our study is to analyze the results of complex femoral shaft fractures treated by intramedullary interlocking nailing in our institution. Totally 20 cases of complex femoral fractures from 2007-2009 were treated with intramedullary interlocking at Krishanakumar Orthopedic Care Hospital, Nagercoil were included in our study.
Results: We found that fracture of femur is most common in 2nd, 3rd and 4th decade of life, with mean age of 35.85 years. Vehicular accident in 17 patients was observed to be the main cause of fracture in our series (85%). 4 patients started full weight bearing at 10th week, 9 patients were able to bear full weight at 12th week, 4 patients at 14th week and 2 at 16th week. Average time of full weight bearing was 12.4 weeks. One patient developed deep infection (osteomyelitis) at 12 weeks and later non union was seen and unable to bear full weight.
Conclusions: Intramedullary interlocking nailing for complex femoral fractures has been established worldwide as the gold standard treatment because of its load sharing property, internal splinting, and rotational stability. These contribute the stable osteosynthesis.
Alho A. Concurrent ipsilateral fractures of the hip and shaft of the femur. Ann Chir Gynecol. 1997;86(4);326-36.
Alonso J, Galilee W, Hughes JL. External fixation of femoral shaft fractures. Clin Ortho. 1989;241:83-8.
Bari BD, Schildhauer TK, Nork SUE. Noncontiguous fracture of the femoral neck, femoral shaft, and distal femur. J Trauma. 2003;55(1):80-6.
Butler MS1, Brumback RJ, Ellison TS, Poka A, Bathon GH, Burgess AR. Interlocking intramedullary nailing for ipsilateral fractures of the femoral shaft and distal part of the femur. J Bone Joint Surg Am. 1991;73(10):1492-502.
Church JC. Segmental fractures of femur. JBJS. 1971;53(2):355.
Connolly JF, Dehne E, Lafollette B. Closed reduction and early cast brace ambulation in the treatment of femoral fractures. JBJS. 1973;55(8):1581-99.
Funk FJ, Wells RE, Street DM. Supplementary fixation femoral fractures. Clin Orthop Relat Res. 1968;60:41-50.
Gates DJ, Alms M .Hinged cast and roller traction for femoral fractures. JBJS. 1985;67(5):750-6.
Pape HC, Grannooudis P. The biological and physiological effects of the femur. JBJS. 2007;89:1421-6.
Chaurasia BD. BD Chaurasia's Handbook of General Anatomy. Human anatomy. 4th edition. Volume 2. CBS Publishers; 2009: 16-22.
Mays J, Neufeld AJ. Skeletal traction methods. Clin Orthop Relat Res. 1974;(102):144-51.
Klemm KW, Börner M. Interlocking nailing of complex fractures of the femur and tibia. Clin Orthop Relat Res. 1986;(212):89-100.
Kontscher G. Practice of intramedullary nailing. Translated by Rinne HH. Springfield, Illinois: Thomas CC; 1967.
Martinus B, Terje T. Torsional deformity after intramedullary nailing of femoral shaft fractures. JBJS. 1993;75;799-803.
Monday V, Nickel VL, Harrey JP. Cast brace treatment for a fracture of the distal part of the femur. JBJS. 1970;52(8):1563-78.
Robert A, Hansen T. Segmental fracture s of the shaft of femur treated by closed intramedullary nailing T. JBJS. 1978;60:934-9.
Robert S, Ganz R. The evolution of femoral shaft plating technique. Clin Orthop Relat Res. 1998;86(4):326-36.
Sharma JC, Gupta SP, Mathur NC, Comminuted femoral shaft fractures. Treatment by closed intramedullary nailing and functional cast bracing. J Trauma. 1993;34(6):786-91.
Thoresen BO, Alho A. Intramedullary interlocking nailing in femoral shaft fractures A report of four cases. JBJS. 1985;67:1313-20.
Turen CH, Brumback RJ. Conversion of external fixation to intramedullary nailing for fracture of shaft of the femur in multiply injured patients. JBJS. 2000;82(6):781-8.
Winquist RA, Hansen S. Closed intramedullary nailing of femoral fractures. A report of 520 cases. JBJS. 1984;66:529-39.