Pitfalls, errors, and complications in the use of locking Küntscher nails

The addition of percutaneously inserted transfixion screws or internally deployed fins supplements the stabilization potential of the cloverleaf nail. The use of these systems increases the indications for reamed closed intramedullary nailing. Fractures with comminution or bone loss, malunions, and nonunions located outside of the isthmic region of the femur and the tibia can now be stabilized effectively with a Küntscher-type implant. These closed nailing techniques reduce blood loss, surgical stress, and complications associated with open reduction and offer the patient the advantages of early joint and muscle rehabilitation and shorter hospitalization. However, the added technical complexity associated with the locking nail introduces a new set of pitfalls, errors, and complications. This article discusses these problems and suggests means to alleviate or avoid certain difficulties.