[Intramedullary nailing of adult femoral fractures].
OBJECTIVE
We evaluated the results of treatment of adult femoral fractures treated by intramedullary nails.


METHODS
Sixty-two patients (15 females, 48 males; mean age 29 years; range 16 to 62 years) with 64 femoral fractures were treated by intramedullary nailing. Eighty-three percent of the fractures was closed and 17% was open. According to the Winquist (W) classification, there were 16 (25%) W0, 22 (34%) W1, nine (14%) W2, nine (14%) W3, and eight (13%) W4 fractures. The mean duration between trauma and surgery was 18 days (range 4 to 130 days), and the mean hospital stay was 25 days (range 11 to 142 days). Open and closed techniques were employed in 62 (97%) and two (3%) fractures, respectively. Nine fractures were unlocked; dynamic and static locking were performed in 39 and 16 fractures, respectively. In the open technique, secondary procedures involved grafting in 14 cases, cerclage in eight cases, grafting and cerclage in 10 cases, and grafting and screw fixation in one case. The results were assessed according to the criteria by Thoresen et al. The mean follow-up was 28 months (range 7 to 62 months).


RESULTS
Fifty-one patients (80%) had satisfactory, 13 patients (20%) had poor outcome. All proximal locking screws (n=20) were successfully inserted, whereas 23 (24%) of 95 distal screws missed the nail holes. Complications included superficial infection (n=3), osteomyelitis (n=4), trochanteric bursitis (n=1), irritation of the skin by the distal screws (n=4), heterotopic ossification (n=6), shortening more than 1 cm (n=8), rotational malalignment greater than 10 degrees (n=2), migration of the nail through the knee joint (n=2), drill breakage while preparing the distal holes (n=2), knee range of motion below 100 degrees (n=6), and delayed union (n=2).


CONCLUSIONS
Intramedullary nailing should be the primary indication for stable and unstable femoral fractures.
Durakbaşa
Oğuz
O
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Kliniği), Haydarpaşa Numune Training Hospital, 34668 Usküdar, Istanbul, Turkey. odurakbasa@yahoo.com
Haklar
Uğur
U
Tuygun
Hakan
H
Türkmen
Metin
M
D000293:Adolescent; D000328:Adult; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome