Abstract
abstract
From July 1997 to March 2001, 209 consecutive patients with 215 femoral shaft fractures amenable to antegrade femoral nailing were enrolled. A true percutaneous insertion technique was performed using a stab wound incision. One hundred ninety-seven (92%) fractures achieved primary union with anatomic or near anatomic alignment. Eighteen (8%) healing problems and two deep infections (1%) responded to repeat interventions. There was one iatrogenic complication related to an anterior starting point. External blood loss was minimal (generally <100 cc). Incisions averaged 16 mm and healed uneventfully. At one-year follow-up only 10% of patients had hip abductor pain. The percutaneous technique appears to be a safe and effective alternative to the standard technique. Hip pain at one year appears decreased compared to reports using a traditional approach.
- 1. Rothwell AG. Closed Kuntscher nailing for comminuted femoral shaft fractures. J Bone Joint Surg Br. 1 982: 64: 1 2- 1 6. Google Scholar
- 2. Stmonian PT, Chapman JR, Selznick HS. Benirschke SK, Claudi BF. Swiontkowski MF. Iatrogenic fractures of the femoral neck during closed nailing of the femoral shaft. J Bone Joint Surg Br. 1994; 76:293-296. Google Scholar
- 3. Winquist RA. Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am. 1 984: 66:529-539. Google Scholar
- 4. Benirschke SK. Melder 1. Henley MB, et al. Closed interlocking nailing of femoral shaft fractures: assessment of technical complications and functional outcomes by comparison of a prospective database with retrospective review. J Orthop Trauma. 1993; 7: 1 18-122. Google Scholar
- 5. Ricci WM. Bellabarba C, Evanoff B, Herscovici D, DiPasquale T, Sanders R. Retrograde versus antegrade nailing of femoral shaft fractures. J Orthop Trauma. 2001; 15:161-169. Google Scholar
- 6. Brumback RJ, Reilly JP, Poka A, Lakatos RP, Bathon GH. Burgess AR. Intramedullary nailing of femoral shaft fractures. Part I: Decision-making errors with interlocking fixation. J Bone Joint Surg Am. 1988; 70: 1441-1452. Google Scholar
- 7. Brumback RJ, Ellison PS Jr, Poka A. Lakatos R. Bathon GH. Burgess AR. Intramedullary nailing of open fractures of the femoral shaft. J Bone Joint Surg Am. 1989; 71:1324-1331. Google Scholar
- 8. Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg Am. 1985;67:709-720. Google Scholar
- 9. Thoresen B. Alho A, Ekeland A, Stromsoe K, Folleras G, Haukebo A. Interlocking intramedullary nailing in femoral shaft fractures. J Bone Joint Surg Am. 1985; 67:1313-1320. Google Scholar
- 10. Wiss DA. Browner BD, Heppenstall RB, Whitelaw GP. Symposium: subtrochanteric femoral fractures: current concepts in treatment. Contemp Orthop. 1994; 29:213-218. Google Scholar
- 11. Braten M, Terjesen T, Rossvoll I. Femoral shaft fractures treated by intramedullary nailing. A follow-up study focusing on problems related to the method. Injury. 1995: 26:379-383. Google Scholar
- 12. van der Hülst RR, van der Wildenberg FA. Vroemen JP. Greve JW. Intramedullary nailing of (impending) pathologic fractures. J Trauma. 1994;36:211-215. Google Scholar
- 13. Johnson KA. Tencer AF, Sherman MC. Biomechanical factors affecting fracture stability and femoral bursting in closed intramedullary nailing of femoral shaft fractures, with illustrative case presentations. J Orthop Trauma. 1987; 1:1-11. Google Scholar
- 14. Johnson K. Femoral shaft fractures. In: Browner B, Jupiter J, Levine A. Trafton P, eds. Skeletal Trauma. 3rd ed. Philadelphia. Pa. WB Saunders Co; 1992:1525-1641. Google Scholar
- 15. Brumback RJ. Wells JD, Lakatos R, Poka A. Bathon GH. Burgess AR. Heterotopic ossification about the hip after intramedullary nailing for fractures of the femur. J Bone Joint Surg Am. 1990;72:1067-1073. Google Scholar
- 16. Marks PH. Paley D. Kellam JF Heterotopic ossification around the hip with intramedullary nailing of the femur. J Trauma. 1988; 28:1207-1213. Google Scholar
- 17. Steinberg GG. Hubbard C. Heterotopic ossification after femoral intramedullary rodding. J Orthop Trauma. 1993: 7:536-542. Google Scholar
- 18. Dodenhoff RM. Dainton JN, Hutchins PM. Proximal thigh pain after femoral nailing. Causes and treatment. J Bone Joint Surg Br. 1997:79:738-741. Google Scholar
- 19. Bain GI, Zacest AC. Paterson DC, Middleton J, Pohl AP. Abduction strength following intramedullary nailing of the femur. J Orthop Trauma. 1997; 11:93-97. Google Scholar
- 20. Winquist RA, Hansen ST Jr, Pearson RE. Closed intramedullary shortening of the femur. Clin Orthop. 1978; 136:54-61. Google Scholar
- 21. Danckwardt-Lilliestrom G, Sjogren S. Postoperative restoration of muscle strength after intramedullary nailing of fractures of the femoral shaft. Acta Orthop Stand. 1976: 47:101-107. Google Scholar
