Locked intramedullary nailing for the treatment of femoral shaft fractures: experience and result in 19 cases.
BACKGROUND
Fractures in the proximal or distal third of the femoral shaft or those with severe comminution are known to be less suitable for intramedullary nailing with Kuntscher nail. With the introduction of interlocking intramedullary nailing the problems of rotational malalignment and shortening that accompany such fractures are now less common. At the National Orthopaedic Hospital Igbobi, Interlocking Intramedullary Nailing was introduced as a form of surgical treatment for fractures of the femur, our initial experience in this type of intramedullary nailing form the basis of this report.


METHODS
This is a retrospective study of all cases of fractured femur that were treated with locked intramedullary nailing between March 2002 and September 2003.


RESULTS
During a 19-month period, 19 patients with 19 fractures were treated for fracture of the femoral shaft with locked intramedullary nailing using the Russell-Taylor (18 fractures) and Grosse-Kempf (1 fracture) nails. Thirteen fractures (68.5%) had comminution of the Winquist-Hansen type III and IV 12 of which were statically locked. There were three intra-operative technical problems including the case of a subtrochanteric fracture, where the nail missed the medullary canal of the proximal segment. There were 2 cases of superficial wound infection, which responded to local wound care and antibiotics. Although limb length discrepancy and rotational mal-alignment were not assessed routinely during the follow-up of patients, no symptomatic malrotation was recorded. Sixteen out of the 19 patients were available for follow-up for an average period of 11 months. All these cases progressed to union, without the need for dynamization in statically locked fixations.


CONCLUSIONS
In spite of the initial problems encountered with this relatively new procedure in our centre, we were able to achieve a reasonably good result in addition to supporting the notion that dynamization of a statically locked nail is not always necessary for healing of fractures.
Fadero
P E
PE
National Orthopaedic Hospital, Lagos, Nigeria.
Alabi
S
S
Adebule
G T
GT
Odunubi
O O
OO
Yinusa
W
W
Eyesan
S U
SU
Obianyor
O D
OD
D000328:Adult; D000368:Aged; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D005596:Fractures, Closed / Q000601:surgery; D018460:Fractures, Comminuted / Q000601:surgery*; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies