Intramedullary osteosynthesis. 1. Küntscher nailing in the femur.

Based on more than 20 years experience, the authors support the effectiveness of intramedullary nailing in the treatment of diaphyseal fractures of the femur. They review the history and advantages of this method and discuss the biomechanical principles on which it is based. Recent advances in technique have made it possible to secure proximal and distal anchorage in cancellous bone. This allows the method to be extended to more proximal and distal fractures than in the traditional method which is applicable only to the middle third. It also facilitates progressive axial compression, early loading and early mobilisation of the limb, thus creating the optimum biological conditions for consolidation and joint function. The closed method also reduces blood loss and the risk of infection. The techniques adopted to deal with more complex situations are described. These include moderately comminuted oblique and spiral fractures and certain bifocal fractures. Finally, the results of treating 450 cases are reviewed, with a longterm analysis of 198 patients.