title: Slotted versus non-slotted locked intramedullary nailing for femoral shaft fractures.
abstract: Experimentally, two slotted nails, the Grosse-Kempf nail and the AO/ASIF universal femoral nail, were compared to the non-slotted Grosse-Kempf nail and control bone using a cadaver femoral osteotomy. The stiffnesses and strengths of the osteotomies fixed with slotted nails in 10-30 degrees torsion were 6-8% and the values of non-slotted nails 40% of control bone. The maximal moments were 14-18% and 48%, respectively. In the "clinical range" of torsion, the implant-bone construct never failed or was deformed. Clinically, 46 femoral shaft fractures were randomized to treatment with Gross-Kempf nails, 24 with slotted nails and 22 with non-slotted nails. Four complications in the slotted nail group and three in the non-slotted nail group were considered to be independent of the choice of nail and did not affect the end result. Three splinterings of the distal fragment, one resulting in a change of the osteosynthesis implant to a condylar plate, were considered to result from the high stiffness of the non-slotted nail. Osteosynthesis of femoral shaft fractures using slotted nails has not resulted in healing disturbances, which could be accounted for by the high torsional elasticity of the nail; there seems to be no indication for high-stiffness nails in femoral fractures.
authors.affiliation: Orthopaedic Department, Ullevål Hospital, University of Oslo, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Alho
authors.forename: O
authors.initials: O
authors.lastname: Moen
authors.forename: T
authors.initials: T
authors.lastname: Husby
authors.forename: H
authors.initials: H
authors.lastname: Rønningen
authors.forename: S
authors.initials: S
authors.lastname: Skjeldal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications