Radiographic and functional results of osteosynthesis with locked unreamed intramedullary nailing of femoral shaft fractures in adults

Abstract

We evaluated the radiographic and functional results of treatment with locked unreamed intramedullary nailing of femoral shaft fractures in adults. 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 bilateral 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 criteria. The mean follow-up was 25 months (range 12 to 54 months). 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 hospitalization 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 complications included delayed union in four patients, nonunion in one patient, and superficial infection at the site of distal screws in two patients. Intramedullary locked nailing may be the preferred 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.