Retrograde intramedullary nailing, without reaming, of fractures of the femoral shaft in multiply injured patients.

Twenty consecutive multiply injured patients who had a total of twenty-two fractures of the femoral shaft were managed with intramedullary nailing without reaming. A retrograde technique through the intercondylar notch of the knee was used. All patients were followed for at least one year or until union of the fracture. The operative time for the nailing averaged seventy-five minutes (range, thirty-five to 105 minutes). Union of the fracture occurred at an average of fifteen weeks. There were three non-unions and one rotational malunion. There were no infections, and no nail or screw failed. Normal motion of the knee was regained by all patients, except one who had had an ipsilateral dislocation of the knee. On the basis of these preliminary results, we concluded that retrograde nailing is a safe and effective technique for multiply injured patients. The apparently higher prevalence of non-union compared with that reported with antegrade nailing with reaming warrants additional study.