title: Expandable intramedullary nailing for tibial and femoral fractures: a preliminary analysis of perioperative complications.
abstract: OBJECTIVE
  To report the results of using the expandable nailing system in the treatment of femoral and tibial shaft fractures.
  
  
  METHODS
  Prospective, cohort series.
  
  
  METHODS
  Two level-1 university trauma centers.
  
  
  METHODS
  Forty-eight patients with acute, traumatic diaphyseal fractures of the tibia or femur.
  
  
  METHODS
  Internal fixation of lower extremity long bone fractures using expandable intramedullary nailing.
  
  
  METHODS
  Perioperative complications and time to healing.
  
  
  RESULTS
  Forty-nine long bone fractures were treated: 22 femoral fractures (OTA classification: 4 type A1, 6 A2, 7 A3, 1 B1, and 4 B2) and 27 tibial fractures (OTA classification: 4 type A1, 11 A2, 9 A3, 0 B1, and 3 B2). There were 13 open fractures and 37 closed fractures. Healing occurred in 37 (75%) fractures without additional interventions. There were 2 tibial delayed unions and 1 femoral and 1 tibial nonunion. Five tibial shaft fractures and 6 femoral fractures shortened by 1.0 cm or more postoperatively. In 3 tibias and 4 femurs, shortening occurred after fractures judged to be length-stable became unstable because of fracture propagation during nail expansion. Five tibias and 3 femurs were converted to standard locked nails because of shortening. The average time to healing, excluding nonunion, was 15 weeks in the tibia and 16 weeks in the femur. The expandable nail resulted in an unplanned reoperation in 12 cases (25%).
  
  
  CONCLUSIONS
  We found a high complication rate because of shortening, which was independent of fracture classification. Consequently, we cannot recommend the use of an unlocked, expandable nail in diaphyseal fractures of the femur or tibia.
authors.affiliation: Department of Orthopaedic Surgery, Denver Health Medical Center, CO 80204, USA. wsmith@dhha.org
authors.forename: Wade R
authors.initials: WR
authors.lastname: Smith
authors.forename: Bruce
authors.initials: B
authors.lastname: Ziran
authors.forename: Juan F
authors.initials: JF
authors.lastname: Agudelo
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Morgan
authors.forename: Zachery
authors.initials: Z
authors.lastname: Lahti
authors.forename: Todd
authors.initials: T
authors.lastname: Vanderheiden
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
mesh_terms: D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D011859:Radiography; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome