Abstract
For unstable fractures of the femoral shaft, the current interlocking nails are the most reliable fixation. However, these procedures require the use of an image amplifier for targeting the distal screws, and are expensive, ancillary instrumentation and an extensive stock of numerous nail sizes with various diameters, sides, and lengths is necessary.
We report a consecutive series of 60 unstable femoral fractures treated with the Endolock nail. This closed 11 mm diameter nail is introduced after little or no reaming. Distal fixation is achieved by means of a spur that unfolds from the nail and fixes into the posterior metaphysis. Radiological control during the procedure is recommended but not mandatory.
Fusion was achieved in all cases but three (5%). Two were aseptic in the same patient who presented two upper limb non-unions, and one with infection (little or no reaming was used in the nine open fractures). Eight moderate mal-unions were observed (angulation < 10°, external rotation < 20°, shortening < 20 mm) but did not require re-operation. All of these were the consequence of insufficient reduction of the fractures. No secondary displacement occurred between operation and fusion. No complications related to spur penetration or removal were observed.
The Endolock nail allows satisfactory interlocking without the mandatory use of an image amplifier, with little or no reaming, and at a low cost.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
