Technical aspects of midshaft femoral shortening with Küntscher nailing

Surgical shortening of the lower limb in adults with unequal leg length is a rare procedure making up about 0.05% of all orthopedic operations. Most often a subtrochanteric level and nail-plate fixation is used. Early weight-bearing with this technique can, however, result in metallic failure. As is illustrated in 11 cases, midshaft femoral shortening operations with intramedullary nailing are hazardous because of rotational or longitudinal instability. As a precautionary measure, extra reaming and locking osteotomy can be performed. This makes intramedullary nailing a relatively safe procedure, and allows immediate full weight-bearing.