Technique of closed unlocked femoral nailing using ultrasound guidance

We report a method of closed femoral nailing, without locking, using only ultrasound guidance from the beginning to end of the operation. The method was evaluated as a prospective study in 150 cases of unilateral femoral mid-shaft fracture that underwent surgery within 1 week. There were 132 males and 18 females aged from 16 to 70 years (mean 26). The interval from injury to operation averaged 2.3 days (range 1-7). Twenty-seven cases had Winquist I comminution and 123 cases had no comminution. In 145 cases (97%), we were successful using this method, with an average operation time of 35.8 min (range 30-50). In five cases, we had to change to using fluoroscopic control. Of these, in one case the fracture could not be reduced under ultrasound monitoring, one had nail incarceration, in one there was breakage of the flexible reamer and in two cases we were unable to pass the guide-wire across the fracture within 10 min. Ultrasound is readily available in most hospitals and can be used as an alternative method for monitoring the fracture alignment in closed unlocked femoral nailing.