Radiographic and functional results of osteosynthesis with locked u n reamed intramedullary nailing of femoral shaft fractures in adults

Obj ectives : We evaluated the radiographic and functional results of treatment with locked unreamed intramedullary nail¬ing of femoral shaft fractures in adults. Methods : Seventy-eight femoral shaft fractures of 70 adult patients (57 men, 16 women; mean age 36 years; range 18 to 77 years) were treated with locked unreamed intramedullary nailing. The fractures were on the right in 39, on the left in 29, and bilat¬eral in five patients. Eighteen patients (24.7%) had open fractures and 28 patients had associated pathologies. The mean time from injury to surgery was 10.7 days (range 3 to 15 days). The fractures were classified according to the Winquist-Hansen system and functional results were evaluated according to the Thoresen crite¬ria. The mean follow-up was 25 months (range 12 to 54 months). Results : Union was achieved in 73 fractures (93.6%) of 69 patients within a mean duration of 14 weeks (range 10 to 28 weeks). Four fractures (5.2%) united after dynamization and one patient (1.2%) required revision with a circular external fixator following dynamization. The mean duration of hospi¬talization was 19.8 days (range 8 to 26 days). According to the Thoresen criteria, the results were excellent or good in 64 patients (87.7%), and moderate or poor in nine patients (12.3%). Fifty-six (76.7%) and 13 (17.8%) patients returned to previous work and daily activities with no or minor limitations in a mean of 12 weeks, respectively. Perioperatively, a distal fissure occurred in nine patients, and distal locked screws were improperly placed in two patients. Postoperative complica¬tions included delayed union in four patients, nonunion in one patient, and superficial infection at the site of distal screws in two patients. Conclusion: Intramedullary locked nailing may be the pre¬ferred method in the treatment of femoral shaft fractures in adults due to high union but low complication rates, early mobilization of the patient, and satisfactory functional results.