In order to define the operative indications, we compared the post-operative complications, time of consolidation, incidence of compartment syndrome, and fat embolism in centro medullary nails made from two different metals. This study includes approximately 234 centro medullary nails (TARGON System) used for treatment of diaphysal fractures of the leg or femur after a skiing injury. Steel nails were used before 1998 and titanium nails after 1998. The time of consolidation was the same for steel nails and titanium reamed nails. We remain faithful to limited reaming which avoids destruction of bone, and cortical and exothermic damage, but enables easier insertion of the titanium nail for leg fractures and bone grafts The incidence of compartment syndrome with use of a titanium nail is reduced threefold. Regarding femoral fracture, the insertion of the nail without wire is more complicated and the operative stage is extended by 25%. The time of consolidation is the same for titanium or steel nails, and there were no failures with either type. However, we advise using titanium reamed nails for leg fractures and steel reamed nails for femoral fractures. If there is a suspicion of fat embolism, it is better to use femoral titanium nails.
