Femoral shaft fractures treated by intramedullary nailing. A follow-up study focusing on problems related to the method.

One hundred and sixteen patients with 120 femoral fractures treated by reamed intramedullary nailing were reviewed. All fractures but one healed without additional procedures. One comminuted fracture had a bone transplant after 8 months to enhance bone remodelling in the lateral part of the fracture area. Three patients developed adult respiratory distress syndrome; all patients survived. Deep infection complicated one osteosynthesis. Thromboembolism was recorded in five cases. Twenty-three patients had a true torsional deformity (anteversion difference of 15 degrees or more), but only nine had complaints. Four of these patients needed a corrective osteotomy. Shortening of 10 mm or more was revealed in 11 patients; only one was above 20 mm. Prior to nail removal, hip and knee pain was present in 26 and 20 per cent, respectively. Few patients had such pain after nail removal. We conclude that reamed IM nailing of femoral fractures gives excellent fracture healing, rapid patient recovery and few complications. Some problems are, however, related to the method: torsional deformity occurs frequently, but will not always cause complaints. Shortening is a potential problem, but dramatic shortenings can be avoided when static locking is used. Hip and knee pain occurs frequently, but will usually disappear after nail removal.