Abstract
Introduction: Intramedullary nailing is an acceptable method of treatment for femoral shaft fractures today. We present our experience from the use-of four different nails.
Patients and Methods: Thirty fractures of the femoral shaft were treated by intramedullary nailing from Jan98–DecOl in our department. The patients’ age ranged from 19 to 87 (avg 36 ys). Twelve fractures were in poly-trauma patients. In 6 patients, due to an intense comminution, an external fixation was initially applied and a delayed intramedullary nailing was performed. Four different types of nails were used 8 Grosse & .Kempf, 1 Orthofix ,2 ZMS (Zimmer), and 19 Marchetti Vicenzi.
Results: All patients were followed up until complete union of the fracture. A 1.5 cm shortening was found in one patient and two patients presented a valgus 7° at the fracture site. One pseudarthosis with broken implant (Marchetti) was seen and treated with a new nail of the same type. The Orthofix nail was used only once due to its lack of anatomic curvature. The mean surgical time of the GK and ZMS nails was 30 minutes more than that of Marchetti nails, due to the distal locking screws required.
Conclusions: In our own experience, GK and ZMS nails provide a larger contact area in the endosteum as well as the best conditions for biomechanically sound distribution of loading. The placement of distal locking screws constitutes a major problem, as it requires extended surgical time and increased exposure to irradiation. The important advantage of the Marchetti nail is that no distal screws are required, so the operation and fluoroscopy time are much shorter. The main disadvantages of the Marchetti nail are the absence of quidewire during nail insertion, the minimal 13mm femoral canal diameter required proximally, the contraindication for very distal fractures and the inability to fully weightbear early.
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