- See:
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Comminuted Femoral Shaft Fractures:
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Distal Femoral Shaft Fractures:
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Infected IM nails:
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Open Fractures
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Proximal Femoral Shaft Fractures:
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Synthes IM Femoral Nail:
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Winquiest Classification
- Discussion: Intramedullary Nailing:
- closed IM nailing has supplanted other forms of treatment
for femur frx;
- it affords predictable realignment of bone, rapid regeneration of bone and union of the fracture,
and early functional use of the limb;
- union can be expected in 28-29 weeks for reamed femoral nails and about 39 weeks for unreamed nails;
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technique considerations:
- in the report by RF Ostrum et al JTO 2000, the authors prospectively compared the results of antegrade vs retrograde IM nailing;
- the authors noted that the two techniques were essentially equally effective in treating shaft fractures;
- retrograde nails had a higher incidence of symptomatic distal interlocking screws;
- in the antegrade group, over 25% of patients had Trendelenburg gait pattern, weakness and or pain;
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antegrade nailing Technique:
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positioning for femoral shaft fractures:
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IM nail entry point:
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reaming and nailing maneuver:
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retrograde nailing Technique:
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comminuted frx:
- in the past, major limitation of all nailing systems has been poor results in comminuted midshaft fractures & in fractures at proximal & distal aspects of the shaft;
- axial and rotatory loads are not neutralized by most nails, and postoperative shortening & malrotation are frequent complications;
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locked nails:
- locking nails has no deliterious effects on healing
- may support 3x forces in axial loading;
- usually unnecessary to reduce comminuted fragments
- dynamic fixation:
- screws in just the proximal or distal holes
- indicated for fractures w/ no potential instability in rotation;
- static fixation:
- w/ screws in both proximal and distal hole
- for frx w/ both shortening and malrotation are possible;
- increases stiffness of the nail in torsion;
- stress shielding is Not clinically significant;
- Wiss et. al. Clin. Orthop. 1986;
- report 98% union rate, < 1% infection
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Complications of IM Nails:
Reamed versus unreamed femoral nails. A randomized prospective trial.
MG Clatworthy et al.
JBJS. Vol 80-B. No 3. May 1998. p 485.
Prospective Comparison of Retrograde and Antegrade Femoral Intramedullary Nailing.
RF Ostrum et al. Journal of Orthopedic Trauma Vol 14. No 7. p 496-501.
