Problems related to blocked nailing in fractures of the proximal femur

The modern treatment of fractures of the proximal femur in the adult usually involves surgery. Open plating has proved to be reliable, but often involves a high percentage of complications: axial deformity, delayed union, breakage of the plate and/or screws (the risk of which increases in relation to the degree of comminution). At this site, in fact, the plate is submitted to strong flexion stress. It therefore becomes essential to associate cancellous grafts (as proposed by the AO School) (Muller et al., 1981) or a homoplastic cortical craft (as in our experience) (Zinghi and Masetti, 1982). Furthermore, open osteosynthesis is time consuming and this means considerable blood loss and a risk of infection. There are thus many reasons for preferring closed surgery, but effective stabilisation can only be obtained with blocked nailing; in fact, only metadiaphyseal screwing is capable of neutralising the rotation or axial stresses which cause deviation, instability or telescoping of the fracture (Kempf et al., 1978; Tigani et al., 1986; Zinghi et al., 1984). Osteosynthesis with Grosse-Kempf nailing is thus an effective alternative to open nailing, particularly in those fractures which would require additional bone grafting with this method. The purpose of our study was to verify the effectiveness of intramedullary osteosynthesis with Grosse-Kempf blocked nailing, in particular analysing the problems encountered in the use of this method.