Immediate interlocking nailing of fractures of the femur caused by low- to mid-velocity gunshots.

A retrospective review of 39 fractures of the femur in 37 patients caused by low- and mid-velocity handgun missiles treated with static interlocking nailing within 18 h of injury was conducted to evaluate the efficacy, safety, and cost savings of immediate intramedullary nailing in these injuries. Patients were followed through union of the fracture with an average follow-up of 12.5 months. The average hospitalization was 8.5 days. All but two fractures healed in an average of 14 weeks (range 8-28). One delayed union was treated with exchange intramedullary nailing with reaming 5 months postinjury and progressed uneventfully to fracture union. One nonunion occurred, presenting with broken distal interlocking screws 18 months after injury, which was treated with an exchange intramedullary nailing with reaming. The nonunion healed within 4 months of this secondary procedure. There were no malunions of > 5 degrees angulation, no leg length discrepancies of > 1.0 cm, and no rotational malalignments noted. There was one (2.5%) infection that was successfully treated with nail removal, reaming of the canal, and reinsertion of a larger diameter nail. We conclude that immediate interlocking nailing of low- and mid-velocity gunshot fractures of the femur is an effective and safe treatment. Compared with previously published data on intramedullary nailing of femoral gunshot fractures, immediate intramedullary nailing resulted in a shorter hospital stay with a significant decrease in hospital expenses. Because the findings of this study indicate that early fixation in these injuries had no detrimental effect on the clinical results, we recommend immediate intramedullary nailing of gunshot fractures of the femur.