Cephalomedullary nailing for proximal femoral fractures

From May 1999 to April 2002, we treated 14 patients with subtrochanteric femoral fractures and seven patients with ipsilateral fractures of the femoral neck and shaft using a second-generation cephalomedullary interlocked nail. Patients mean age was 36 (20-60) years, and 19 fractures were caused by high-energy trauma. Four patients had associated injuries. The average follow-up was 23 (16-30) months. Per-operatively, we had problems in locating the entry portal in four patients, and one nail was driven through the inter-condylar notch. All fractures except two united. One patient had non-union of the femoral neck and one of both neck and shaft. One patient united with shortening of more than 1.5 cm and varus angulation at the fracture site. Two patients had loosening and backing out of the proximal screw. The second-generation cephalomedullary nail is a suitable treatment option for proximal femoral fractures, but it requires a high degree of accuracy and technical expertise.