Interlocking nails for femoral fractures: an initial experience

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Femoral fractures are common injuries requiring surgical intervention.
• Interlocking nails are a standard treatment for femoral shaft fractures.
• Early outcomes of femoral interlocking nail use in a specific urban setting were previously undocumented.

Purpose of the Study:

• To evaluate the clinical and radiological outcomes of the initial 50 femoral interlocking nail applications in a city.
• To identify factors influencing the success or failure of femoral interlocking nail procedures.
• To provide evidence-based recommendations for optimizing femoral fracture treatment with interlocking nails.

Main Methods:

• Retrospective analysis of 50 consecutive femoral interlocking nail procedures.
• Operations performed by 20 different surgeons with an average follow-up of 19 months.
• Clinical and radiological assessment of 43 fractures, evaluating union, alignment, and length.

Main Results:

• A significant rate of complications was observed, including malunion (22/43), shortening (6/43, >2 cm), varus (6/43, >5°), valgus (10/43, >5°), and malrotation (10/43, >10°).
• Two cases of non-union (>26 weeks) and one instance of deep sepsis were reported.
• Five patients with pathological fractures died, and two were lost to follow-up.

Conclusions:

• Optimal nail insertion in line with the femoral shaft axis (piriform fossa) is crucial.
• Static fixation mode is generally recommended for most femoral fractures.
• The lateral table position during surgery may contribute to rotational and valgus malalignment, necessitating careful technique.