Prophylactic femoral stabilization with the Zickel nail by closed technique

From 1974 to 1983, forty-three femora in forty patients with metastases to the subtrochanteric area were stabilized using a Zickel subtrochanteric device. Thirty-five patients with thirty-eight stabilized femora could be evaluated at follow-up times ranging from thirty-seven days to five years and one month. In twenty-eight of the thirty-eight femora, a modified technique for insertion of the device had been used. Twenty-eight (80 per cent) of the patients were able to walk after an average of 3.8 days. No patient who had been able to walk preoperatively lost that ability. The average length of survival was 312 days postoperatively. Fifteen patients survived for at least fifteen months and five patients, with an average length of survival of 1276 days, were still alive at the time when this review was initiated. Complications included four perioperative deaths, one non-fatal pulmonary embolus, and five intraoperative technical complications--four of them occurring before the described modification of the technique was instituted. There were no infections and no failures of the device. No patient had a loss of stability after Zickel nailing. The modification of the technique allows safer introduction of the intramedullary nail into the weakened but intact femur by a closed method.