Stabilization and prosthetic replacement in difficult fractures and bone tumors.

Comminuted fractures of the femoral shaft, especially when combined with fractures of the hip, may be difficult to treat. A four-sided titanium alloy locking nail with transfixing screws was designed in 1967 and allows compression of the fracture site. If necessary, the nail may be inserted without intraoperative roentgenograms, and permits early weight-bearing in most cases. One hundred seventy-one difficult fractures in femora, humeri, tibiae, and ulnae have been treated with this nail since 1974. Many cemented total hip arthroplasties are failing. A cementless, modular titanium alloy and alumina hip, based on the nail with a modular alumina or titanium head, will allow cementless hemi- or total hip arthroplasty. Porous, 200-microns ceramic coating on the stem allows bone ingrowth while transfixing screws allow full and immediate postoperative weight-bearing. A ceramic sleeve and spacers also allow modular replacement of the upper three-quarters of the femur for tumors and trauma. A similar shoulder and humerus is also available. Fifty-four hips and two shoulders have been successfully replaced since January 1983. In addition, 285 bones with pathologic or potential pathologic fractures caused by secondary tumors have been stabilized by the author between August 1972 and August 1986, with a variety of implants.