Interlocking nails for femoral fractures: an initial experience

We report the results of the first 50 femoral interlocking nails used in our city. The operations were performed by 20 different surgeons. The follow-up interval averaged 19 months. Five patients with pathological fractures died during this period and two could not be traced. Forty-three fractures were assessed clinically and radiologically by one of the authors. Malunion and/or shortening occurred in 22 patients. Six patients had varus (greater than 5 degrees), ten patients valgus (greater than 5 degrees) and ten patients had malrotation (greater than 10 degrees). Six patients were shortened (greater than 2 cm). Two cases progressed to non-union (greater than 26 weeks), and one had deep sepsis. We discuss the effect of insertion point, dynamic versus static fixation and the lateral table position on the final results. It is concluded that: 1. The nail should be inserted in line with the axis of the femoral shaft. This point is usually in the piriform fossa. 2. The static mode should be used for most fractures. 3. The lateral table position may result in rotational and valgus malalignment.