Intramedullary nailing combined with cerclage wiring in the treatment of fractures of the femoral shaft.

One hundred sixty-seven femoral shaft fractures were treated with open intramedullary nailing and cerclage wires. Complications requiring surgical reintervention developed in 11 patients (6.6%). Delayed union or nonunion in five patients (3%), deep infection in four patients (2.4%), or unstable fixation in two patients (1.2%) required one or more additional procedures to achieve union. The time to weight-bearing averaged 32 days in patients with isolated injuries and 62 days in patients with associated injuries. One hundred forty-five patients were followed until fracture union occurred. Rotational malalignment in one patient, angulation of 10 degrees or more in two patients, and limb shortening of more than 2 cm in two patients were noted. Loss of hip or knee motion in excess of 20 degrees developed in 15 patients and was always associated with injuries of the pelvis or ipsilateral lower leg. Intramedullary nailing and cerclage wiring significantly expands the indication for intramedullary fixation of fractures of the femoral shaft.