The problems encountered in the treatment of femoral fractures with locked intramedullary nailing

Abstract

Objectives: To evaluate the problems encountered intraoperatively and postoperatively during the treatment of femoral fractures with locked intramedullary nails. Methods: The study included 94 femurs of 92 patients whose follow up had been made until fracture healing. The patients (70 males, 22 females; mean age 35.6 years; range 17 to 73 years) were treated with the use of five different locked intramedullary nails. Problems encountered during surgery and throughout the follow-up period were evaluated. Results: Intraoperative problems were commonly related to the placement of distal interlocking screws. Of 64 femurs in which nails with distal guide systems were used, the procedure was prolonged and fraught with problems in 35 femurs (54.6%). Other problems were failure to forward the guide pin to the distal fragment, unavailability of nails with appropriate size, perforator break-down, inadequate entry portals, jamming of bony fragments into the nail hole, supracondylar fracture through the distal locking screw, and wedge-like fracture in the proximal-anterior part of the femur. The leading postoperative problem was irritation due to distal locking screws (18 patients, 19.1%). Others included bursitis in the proximal part of the nail, malunion, infection, varus deformity, shortening, thigh pain, breaking of the nail, and loosening of the distal locking screws from the medial cortex. Conclusion: The most complicated part of locked intramedullary nailing is the distal locking of the nail with the screw. The problems encountered can be minimized by appropriate preoperative preparation, technique, equipment, and enhanced experience.