[Closed femoral intramedullary nailing without drilling--a 14-year evaluation]

A sufficiently stable osteosynthesis is demanded on the basis of the conditions formulated for the healing of bone fractures. This demand applies to fractures in general. For intramedullary nailing in particular, it is a major postulate that sufficient stability can only be attained if the medullar cavity is drilled open. Such drilling aims at establishing an extended contact between the cortical substance of the bone and the nail while exercising at the same time a clamping force that is elastic in transverse direction. In our accident emergency hospital (Ludwigshafen) the medullar cavity is not drilled open. This entails the use of frequently very thin intramedullary nails so that the nail can pass through the hourglass-like narrow pathway in the centre. Although this kind of osteosyntheses is insufficient in respect of stability and ensuring rotation, the healing of bone fractures does not present any problems. As a matter of fact, 450 femurs have been treated at our hospital during the pase 14 years with intramedullary Küntscher nailing without drilling. It is demonstrated that this kind of stabilising the fracture is associated with an extremely low incidence of pseudarthroses and infections. Further complications are stated.