RETROSPECTIVE EXHAUSTIVE ANALYSIS OF A CONSECUTIVE SERIES OF FEMUR NAILINGS FOR FRESH FRACTURES

Abstract

Purpose of the study: Locked centromedullary nailing (LCMN) has become the gold standard treatment for fractures of the femur (I. Kempf, Chirurgie 91 ; 117 : 478 / Borel R.C.O. 93 ; 79,553 / Wolinsky J. trauma 99, 46 : 382). Nevertheless, the SOFCOT 2004 round table emphasized the frequency of complications related to inappropriate material and techniques. The series studied had several biases: multicentric recruitment, materials with different designs, high percentage of patients lost to follow-up. In order to overcome these shortcomings we reviewed retrospectively a consecutive series of LCMN performed in a single center from 2001 to 2002, attempting to be as exhaustive as possible.

Material and methods: The study group included 78 patients (81 LCMN) aged 30 years on average (range 16–87 years) with male predominance (69%). A large proportion of patients were traffic accident victims (44% two-wheel vehicles, 42% four-wheel vehicles). The fracture was open in 8% and 65% of patients had multiple fractures (11% floating knees, 23% multiple trauma). The fractures were simple (43%), wedge (47%) and comminutive (10%). Time to operation was 7.4 hr on average for 83% of patients. Mean reaming was 12 mm (range 11–14 mm). An 11-mm (range 10–13 mm) static Grosse and Kempf (Stryker) nail was used in all patients. Intraoperative complications occurred in 8% of cases with no effect on bone healing.

Results: Three patients died from severe head trauma. Five patients were lost to follow-up. Written follow-up data were available for six patients and 64 patients were reviewed clinically. Among the 70 fractures with known outcome, four had not healed (with two screw failures and one nail failure). Knee motion was normal in all patients. Anteroposterior and lateral alignment was normal (±5°) in 94% with no leg length discrepancy (< 10 mm)in 87%. The nail was withdrawn in 84% of patients and the withdrawal procedure was complicated in three cases (hematoma, screw failure). Mean hospital stay for single-fracture patients was 9.7 days for nailing and 2.2 days for nail removal.

Discussion: LCMN is a reliable technique which provides constant clinical results when applied with rigorous technique. The logistics is resource intensive. Nonunion can be revised with the same method. A new nailing with second reaming should be performed early in the event of late healing.