Closed Antegrade Interlocked Nailing of Femoral Shaft Fractures Operated up to 2 Weeks Postinjury in the Absence of a Fracture Table or C-arm

Abstract

Delayed closed nailing of femoral fractures can be achieved without a C-arm or a fracture table provided adequate skeletal traction is applied preoperatively and proper attention is paid to the surgical steps as described.

Nail over nail technique for distal locking of femoral intramedullary nails

“…Although reaming can have an early deleterious effect on endosteal and cortical blood flow, canal reaming appears to have several positive effects on the fracture site, such as increasing extraosseous circulation, which is important for fracture healing [2]. Union at the fracture site was not affected in this series nor in another series of closed antegrade interlocked nailing of femoral shaft fractures in 200 patients where the canal was reamed 2 mm more than the diameter of the nail to prevent deformation of the nail [1]. Over-reaming results in the insertion of a smaller diameter nail, which has been implicated as a biomechanical cause of nail failure [19].…”

“…The far cortex can now be drilled and the screw inserted [15]. Aiyer et al reported successful use of Dr. Tanna's technique in the instance when the jig did not work [1]. All these techniques [12,13,15] still need radiographic images for distal locking whereas the nail over nail technique of distal locking is almost radiation independent as radiographic images were taken only to confirm screw placement or when some intra-operative difficulty occurred.…”

Minimally invasive treatment of displaced femoral shaft fractures with a rapid reductor and intramedullary nail fixation

“…In case of young adult patients or old femoral fracture, a larger force is needed to reduce fracture; however, prolonged traction with a large force may lead to stretch injury of the foot, pudendal nerve trauma, perineal ulcers, peroneal nerve palsy and compartment syndrome [4][5][6][7][8][9][10]. Some surgeons may prefer to not use a fracture table even if not contraindicated for other reasons [15]. Several tools and techniques have been employed to achieve fracture reduction for IM nailing of femur fractures [3], including reduction finger [16], femoral distractor [17,18], a BF-tool^ [19] and a fracture reducer [20,21].…”

Is there a place for open intramedullary nailing in femoral shaft fractures?

“…[13] According to the majority of studies ream intramedullary technique is the preferred method and has a greater chance of healing and lower rate of complications with regard to unreamed technique. [7121415161718] From the early papers until now, there are still controversies in results of femoral shaft fractures treated by close versus open IMN. [715192021222324]…”