Treatment of femoral shaft fractures and pseudoarthrosis with compressive and interlocking intramedullary nailing

Objectives: We evaluated the results of compressive and interlocking intramedullary nailing in femoral shaft frac¬tures. Methods: Thirty-three femoral fractures of 30 patients (23 males, 7 females; mean age 36.9 years; range 14 to 80 years) were treated by compressive and interlocking intramedullary nailing. There were 26 closed and seven open (2 type II, 5 type IIIA) fractures. In three femurs, intramedullary nailing was performed due to pseudoarthrosis. According to the Winquist classification, there were 13, 8, 8, and 4 type I to IV fractures, respectively. Clinical, radiographic, and functional results were evaluated according to the Thoresen criteria. The mean follow-up was 29 months (range 6 to 29 months). Results: The mean operation time was 105.7 minutes. Union was obtained in all the patients within a mean dura¬tion of 19.6 weeks. In six cases, dynamization was per¬formed due to insufficient callus formation. The results were excellent in 17 patients (56.7%), good in eight patients (26.7%), fair in three patients (10%), and poor in two patients (6.7%). Complications included shortening (n=3; 2 to 4 cm), varus deformity (n=2; 8 and 11 degrees), exter¬nal rotation (n=3), restriction in knee flexion (n=3), super¬ficial infection (n=8), trochanteric bursitis (n=3), and irri¬tation of the skin by distal screws (n=2). Conclusion: High rates of union with low complication rates makes interlocking intramedullary nailing an appro¬priate method in the treatment of femoral shaft fractures in adults. Compression with top screws contributes to the stability of fixation by eliminating any looseness through the fracture line.