Orthopedic Trauma Directions 2005; 3(6): 39-43
DOI: 10.1055/s-2005-919136
Classic article review
© Georg Thieme Verlag Stuttgart · New York

Intramedullary nailing of femoral shaft fractures. Part I: Decision-making errors with interlocking fixation.

J Bone Joint Surg Am; 70 (10): 1441 - 1452 R.  J.  Brumback, J.  P.  Reilly, A.  Poka, R.  P.  Lakatos, G.  H.  Bathon, A.  R.  Burgess (1988)
Further Information

Publication History

Publication Date:
02 January 2006 (online)

Author summary

Of 133 dynamic femoral intramedullary nailing (IM) procedures performed after locking techniques became available:

  • 10.5% (n = 14) were complicated by loss of postoperative fixation and reduction.

  • 13 of the 14 femora shortened an average of 2.0 cm and one shortened slightly with clinical loss of rotational stability.

  • Errors in surgical judgment were attributed to (alone or in combination):

  • Inadequate preoperative analysis of fracture patterns

  • Undetected comminution during reaming or nail insertion

  • Failure to recognize postoperatively increased comminution

  • Fracture instability

Authors suggest:

  • Use of high-quality preoperative x-rays to detect nondisplaced comminution of major fracture fragments.

  • Intraoperative fluoroscopic assessment: increase in comminution secondary to reaming or nail insertion is an indication for static locked fixation.

  • Analysis of radiographs taken immediately postoperatively while patient is still under anesthesia to evaluate previously undetected instability that should be treated by static locked fixation.

  • Dynamic IM stabilization should be reserved for transverse or short oblique fractures at the femoral isthmus that have type I or type II comminution.

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