The Huckstep intramedullary compression nail. Indications, technique, and results.

A four-sided, intramedullary compression nail of solid titanium alloy has been developed since 1967. This nail is 12.5 mm in diameter with 4.5-mm transverse holes at 15-mm intervals, for 4-mm fine threaded screws. It has four oblique holes in the proximal end to allow 4.5-mm lag screws to be inserted up the femoral neck. A compressor over the trochanter can be used for compression in transverse fractures. Advantages include inert titanium alloy, which is stronger than the average femoral shaft, a recessed end of the nail, reaming to only 13 mm, and a quadrilateral shape. No operative roentgenograms are usually required. Comminuted, oblique, and infected fractures of the entire length of the femoral shaft down to the supracondylar region can be held rigidly, usually allowing for immediate weight-bearing. The femur can be lengthened or shortened with compression and the knee can be arthrodesed with a 60-cm nail. One hundred twenty-two nails inserted since 1974 included 32 comminuted or oblique acute femoral fractures. Forty-two patients had had failure of other implants. Among these, 34 had nonunion for one year and 17 nonunion for more than three years. Fifty-one bones in 47 patients were stabilized for pathologic fractures and other conditions. Complications were minimal.