Intramedullary Kuntscher Nailing Intensified With Cerclage Wiring to Treat Acute Closed Shaft Fractures of Femur: A Series Cases

Abstract

Between March 1985 and March 1987, we performed 98 surgeries (96 patients) of Intramedullary Kuntscher Nailings Intensified with Cerclage Wiring (if fractures unstable) to treat the fresh closed Fractures of Shaft Femur. Accessing the fractures by Posterolateral Approach, remove soft tissues, hematoma interposing between fragments, reaming medullary canal, performing good reduction, then stabilizing by an Intramedullary Kuntscher Nail. If the fractures not stable enough, Loops of Wiring were intensified. Postoperatively,walking with crutches, and gradual weight bearing according to the extent of bone healing. Physical Therapy focused on Range of Motion (ROM) of hip, knee and ankle. Loss of follow-up: 20 patients (22 femurs). 76 patients (76 femurs) were followed-up for a mean of 27 months (6 to 108). 61 femurs achieved complete bone healing (evaluated on patients and Xrays) with no incidents.18 femurs /patients were removed Kuntscher nail after in average 32 months (22- 48). Allowing Full Weight Bearing in average after 50 days if fracture simple, after 70 days if there were additional fractures. All 13 patients who lost ROM of hip or knee more than 200 , sustained associated injuries of pelvis or legs. Reoperation: 5 femurs (5 %) including delayed and nonunion: 2 femurs (2 %), deep infection: 2 femurs (2%).Surgical fixation not stable enough needed one or more interventions: 1 case (1%). One patient remained rotational displacement 100 ; 3 others with angulation 30 -60 . Leg shortening in average 2,4cm [1-4 ] : 6 femurs ( patients) in which 2 had shortening more than 2 cm. In Vietnam at that time, for the femoral shaft fractures, Intramedullary Kuntscher Nailing with Cerclage Wiring (if fractures unstable) were resumably an acceptable good treatment.