Anterograde femoral nailing with a reamed interlocking titanium alloy nail

Intramedullary nailing has become the gold standard for treatment of femoral diaphyseal fractures. Between March 1995 and December 1998 we performed 40 intramedullary nailings using the ACE femoral nail (De Puy). The patients were followed for an average of 27.9 months (range: 6-54 months). The mean age was 33.2 years (range: 17-87 years); the sex distribution was 33 males and 7 females. All fractures were unilateral (right 18, left 22). Most of the fractures were caused by traffic accidents (35), the others originated from sports, work and gunshot (1). Thirty-five fractures were closed and 5 were open: 1 was grade I, 2 were grade II and 2 grade IIIa according to Gustilo's classification. According to the AO classification 18 fractures were type A, 13 type B and 9 type C. The majority of patients had associated injuries: neurotrauma 2, chest trauma 2, and other fractures e.g. of the clavicula, lumbar spine, patella, tibia. Immediate surgery was performed in 34 cases, delayed surgery in 6 cases. All fractures were treated on a fracture table, with closed reduction, reaming of the intramedullary canal, proximal and distal locking and intraoperative control of rotation and length. The mean time to healing was 17.85 weeks (range: 18-50 weeks). The following complications were observed: 3 delayed unions, which united after dynamisation, one malunion, which required corrective osteotomy, and one nonunion, which healed after exchange nailing. We encountered no rotational deformity and no clinically relevant shortening. Six nails were removed due to irritation by locking screws. These results are comparable with those of larger series in the literature with other types of interlocking nails. The union rate in this series was 97.5%.