The risk non-union following closed-focus nailing and reaming. Results of 1059 interventions using the Kunstcher method

Abstract

The authors have studied a series of 1059 compound and closed fractures of the diaphysis of long bones treated by intramedullary nailing according to the technique of Kuntscher, to assess the incidence of non-union. Between January 1st 1967 and December 31st 1980, 503 fractures of the tibia, 440 of the femur and 116 of the humerus were so treated in both adolescents and adults. The fractures were mostly sustained in road traffic accidents. The risk of aseptic non-union was small, but occurred more readily when the skin was damaged and when the site of the fracture was at the junction of the lower two quarters of the tibia; the incidence was highest when the technique of nailing was incorrect or when the going was undertaken too late. The incidence of non-union and infection are compared with those of other series using the same closed technique and with reports describing insertion of the nail of the plate by opening the fracture. It is concluded that intramedullary nailing using the Kuntscher technique is the most reliable treatment for this type of injury for routine use in an acute fracture service. In this series the incidence of aseptic non-union was approximately 1%, of infection with non-union less than 0.5% and of early infection with eventual union less than 1.5%.