Closed fixation of femoral shaft fractures using the schneider intramedullary nail.
A modification of the closed intramedullary nailing technique of Kuntscher was used in 102 femoral shaft fractures over a 30 month period. In the technique described here, the Schneider intramedullary femoral nail is used instead of the hollow cloverleaf Kuntscher nail, and the femoral canal is reamed only to 12 millimeters instead of the 16 to 20 millimeters recommended by Kuntscher. As with the original closed Kuntscher technique, this method has been applied toa broad variety of femoral shaft fractures including grossly comminuted, segmental, and eccentrically situated fractures. Despite the inclusion of these difficult-to-treat fractures, the complications have been few, blood loss has been minimal, and healing of the fractures with early abundant circumferential callus has been noted. The authors believe that the closed technique in treatment of femoral shaft fractures is the treatment of choice and have used the Schneider nail because it can be used with rather limited reaming of the medullary canal, and is less apt to bind in the femoral canal. Although the technique of insertion differs from the open technique, the nail itself can be used without modifications.
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