Unreamed Nailing of Femoral Fractures with the Solid Femoral Nail

Abstract

In order to reduce pulmonary complications after reaming and intramedullary nailing, a solid 8.5 mm femoral nail was developed. Clinical application of the solid femoral nail in 25 cases of diaphyseal fractures showed promising results. The series consisted of 21 closed fractures, three Grade I fractures, and one Grade III B open fracture. A solid femoral nail was applied eight times in the course of polytrauma, in six patients with multiple injuries, and in 11 patients with isolated femoral fractures. Application was bilateral in three patients. The rate of union was 92 % at 6 months postoperatively. Reaming and renailing were necessary in one patient with deux étages and in one with a pathological fracture. In the latter, nail failure occurred. Bone grafting was needed in one case of pathological fracture. Locking-screw breakage was observed in three (12 %) cases 12 to 25 weeks postoperatively but did not lead to any additional complications. There was one intraoperative complication but no infections were observed. The excellent results of unreamed nailing with the solid femoral nail consequently led to its use as the primary method of treatment of femoral fractures associated with polytrauma, multiple injuries, thoracic trauma, narrow medullary cavity, and pathological fractures, in the presence of concomitant peripheral vascular diseases.

Key words

Femur - fracture - solid femoral nail - treatment

References

• 1 Barie P S, Malik A B. Role of intravascular coagulation and granulocytes in lung vascular injury after bone marrow embolism.  Circ Res. 1982;  50 830
• 2 Gäbler C, Stanzl-Tschegg S, Heinze G, Holper B, Milne T, Berger G, Vécsei V. Fatigue strength of locking screws and prototypes used in small-diameter tibial nails: a biomechanical study.  J Trauma. 1999;  47 379-384
• 3 Goris R JA. The adult respiratory distress and multiple organ failure syndrome.  Hefte Unfallheilkunde. 1990;  212 511-519
• 4 Grosse A, Christie J, Taglang G, Court-Brown C, McQueen M. Open femoral shaft fracture treated by early intramedullary nailing.  J Bone Joint Surg [Br]. 1993;  75 562-565
• 5 Heinz T. Die knöcherne Konsolidierung von Osteotomien an Primatenfemura. Eine tierexperimentelle Studie unter Anwendung verschiedener intramedullärer Verfahren und Implantatwerkstoffen.  Osteosynthese International. 1996;  4, Suppl 3-43
• 6 Kempf I, Grosse A, Lefforgue B. L‘apport du verrouillage dans l'encloue centro-médullaire des os longs.  Revue des Chirurgie Orthopédique. 1978;  64 635-651
• 7 Klemm K, Schellmann W D. Dynamische und statische Verriegelung des Marknagels.  Monatsschr Unfallheilk. 1972;  75 568-575
• 8 Krettek C, Schulte-Eistrup S, Schandelmayer P, Rudolf J, Tscherne H. Osteosynthese von Femurschaftfrakturen mit dem unaufgebohrten AO-Femurnagel (UFN). Operative Technik und erste klinische Ergebnisse mit Standardverriegelung.  Unfallchirurg. 1994;  97 549-567
• 9 Kröpfl A, Naglik H, Primavesi C, Hertz H. Unreamed intramedullary nailing of femoral fractures.  J Trauma. 1995;  38 717-726
• 10 Kröpfl A, Berger U, Neureiter H, Hertz H, Schlag G. Intramedullary pressure and bone marrow fat intravasation in unreamed femoral nailing.  J Trauma. 1997;  42 946-954
• 11 Küntscher G. Practice of Intramedullary Nailing. Charles C Thomas, Springfield, Illinois 1967
• 12 Meade P, Shoemaker P C, Donelly T J. et al . Temporal patterns of hemodynamics, oxygen transport, cytokine activity and complement activity and the development of adult respiratory distress syndrome after severe injury.  J Trauma. 1994;  36 651
• 13 Manning G B, Bach A B, Hermann C M. et al . Fat release after femur nailing in the dog.  J Trauma. 1983;  23 322
• 14 Pape H C, Regel G, Dwenger A. et al . Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma.  J Trauma. 1993;  35 709
• 15 Pape H C, Auf'm Kolk M, Paffrath T, Regel G, Sturm J A, Tscherne H. Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion - a cause of posttraumatic ARDS?.  J Trauma. 1993;  95 634-640
• 16 Vécsei V. Verriegelungsnagelung.  Hefte Unfallheilkunde. 1986;  182 21-30
• 17 Vécsei V, Heinz T. Die Verriegelungsnagelung langstreckiger Trümmer- und Zweietagenfrakturen an Femur und Tibia. Technik und Ergebnisse.  Unfallchirurg. 1990;  92 512-518
• 18 Vécsei V, Harder H, Heinz T, Greitbauer M, Vécsei N. Der solide Tibianagel (STN) - ein neues Implantat für die unaufgebohrte Verriegelungsnagelung.  Osteosynthese International. 1995;  3 184-191
• 19 Wenda K, Ritter G, Alehrs J. et al . Detection and effect of bone marrow intravasation during operations in the region of the femoral cavity.  Unfallchirurg. 1990;  93 56
• 20 Wenda K, Runkel M, Degreif J, Ritter G. Ursachen und klinische Relevanz der Knochenmarkembolie bei der Marknagelung - Ergebnisse intrafemoraler Druckmessungen und echocardiographischer Untersuchungen.  Injury. 1993;  24 (Suppl 3) 73-81
• 21 Wozasek G E. Gefahren der Marknagelung im Schock.  Hefte Unfallchirurg. 1994;  238 1-71
• 22 Wozasek G E, Simon P, Redl H, Schlag G. Intramedullary pressure changes and fat intra-vasation during intramedullary nailing: An experimental study in sheep.  J Trauma. 1994;  36 202-207