Intramedullary nailing of femoral shaft fractures. Ten years' experience.

In 236 intramedullary nailings of femoral shaft fractures there was a 2 per cent deep infection rate, and a 7 per cent nonunion rate; 87 per cent had good primary healing; 42 per cent had further surgery after the initial nailing (two-thirds for removal of the nail). Statistical analysis of the data does not support the view that delayed internal fixation results in less nonunions. The 55 femurs nailed in the first 3 days had a nonunion rate of 11 per cent, as opposed to a 7 per cent postinjury rate for the entire series, a statistically significant increase in nonunions with the Vesely-Street nail. Intramedullary nailing has the following advantages over treatment with traction: shorter hospital stay; better knee motion; less angulation, and less shortening.