- Post-Procedure: Interlocking Intramedullary (Russell-Taylor) Nailing
- Post-Procedure: Antegrade Femoral Nailing (TriGen Nail)
Post-Procedure: Interlocking Intramedullary (Russell-Taylor) Nailing
POST-PROCEDURE CARE
- Allow touch-down weight bearing on the first postoperative day using ambulatory aids such as crutches or a walker.
- Encourage early hip and knee range of motion.
- Begin quadriceps setting and straight leg raise exercises before discharge from the hospital.
- Begin hip abduction exercises after wound healing.
- Progress weight bearing as callus formation occurs.
- Dynamization may be necessary later if union has not occurred by 6 months.
- Nail removal should not be done before 12 months.
COMPLICATIONS
- Infection
- Delayed union or nonunion
- Painful hardware
- Heterotopic ossification
ANALYSIS OF RESULTS
Intramedullary nailing is the treatment of choice for most femoral shaft fractures and carries a low rate of nonunion and rotational malunion. Infection rates are low, with infection being most common in type IIIB open fractures.
OUTCOMES AND EVIDENCE
- Kropfl et al: no nonunions, infections, or failures with unreamed statically locked AM nails (Ace Medical); 3 varus or valgus nonunions
- Krettek et al: 0% nonunion, 3.5% screw failure, 1.7% nail failure, 1.7% loss of reduction, and 1.7% infection with unreamed AO nailing
- Tornetta and Tiburzi: no differences in operative time, transfusion requirements, or pulmonary complication between reamed and unreamed nails; the unreamed group had two delayed unions and one broken interlocking screw; the reamed group had one angular malunion.
- Winquist: 2.3% incidence of infection in type I and type II open femoral fractures treated with delayed nailing
- Brumback et al: 0% infection in types I, II, or IIIA open fractures, but 11% infection in type IIIB open fractures
- Hansen: 5% incidence of infection in types I, II, and III open femoral fractures treated with immediate reamed nailing
- Moed and Watson: no cases of infection or hardware failure in unreamed retrograde nailing; 13.6% nonunion and 4.5% rotational malunion; knee motion was full in all patients.
- Ricci et al: similar healing rates in retrograde and antegrade femoral nailing; 9% in antegrade group had hip pain and 36% in retrograde group had knee pain.
- Ostrum et al: faster healing with antegrade nailing and more frequent need for dynamization of retrograde nailing; knee pain equal between groups, but more thigh pain in antegrade nailing
Procedure: Interlocking Intramedullary (Russell-Taylor) Nailing
Post-Procedure: Antegrade Femoral Nailing (TriGen Nail)
POST-PROCEDURE CARE
- Allow touch-down weight bearing on the first postoperative day using ambulatory aids such as crutches or a walker.
- Encourage early hip and knee range of motion.
- Begin quadriceps setting and straight leg raise exercises before discharge from the hospital.
- Begin hip abduction exercises after wound healing.
- Progress weight bearing as callus formation occurs.
- Dynamization may be necessary later if union has not occurred by 6 months.
- Nail removal should not be done before 12 months.
COMPLICATIONS
- Infection
- Delayed union or nonunion
- Painful hardware
- Heterotopic ossification
ANALYSIS OF RESULTS
Intramedullary nailing is the treatment of choice for most femoral shaft fractures and carries a low rate of nonunion and rotational malunion. Infection rates are low, with infection being most common in type IIIB open fractures.
OUTCOMES AND EVIDENCE
- Kropfl et al: no nonunions, infections, or failures with unreamed statically locked AM nails (Ace Medical); 3 varus or valgus nonunions
- Krettek et al: 0% nonunion, 3.5% screw failure, 1.7% nail failure, 1.7% loss of reduction, and 1.7% infection with unreamed AO nailing
- Tornetta and Tiburzi: no differences in operative time, transfusion requirements, or pulmonary complication between reamed and unreamed nails; the unreamed group had two delayed unions and one broken interlocking screw; the reamed group had one angular malunion.
- Winquist: 2.3% incidence of infection in type I and type II open femoral fractures treated with delayed nailing
- Brumback et al: 0% infection in types I, II, or IIIA open fractures, but 11% infection in type IIIB open fractures
- Hansen: 5% incidence of infection in types I, II, and III open femoral fractures treated with immediate reamed nailing
- Moed and Watson: no cases of infection or hardware failure in unreamed retrograde nailing; 13.6% nonunion and 4.5% rotational malunion; knee motion was full in all patients.
- Ricci et al: similar healing rates in retrograde and antegrade femoral nailing; 9% in antegrade group had hip pain and 36% in retrograde group had knee pain.
- Ostrum et al: faster healing with antegrade nailing and more frequent need for dynamization of retrograde nailing; knee pain equal between groups, but more thigh pain in antegrade nailing
Procedure: Antegrade Femoral Nailing (TriGen Nail)
