Treating gunshot femoral shaft fractures with immediate reamed intramedullary nailing

Reamed intramedullary nailing was used within 36 hours of patient admission to treat 32 consecutive femoral shaft fractures caused by low-velocity gunshot wounds. The femoral shaft fracture was classified according to the AO system, and comminution was graded according to the classification of Winquest and Hansen. Patients were followed for an average of 14.7 months (range, 6 to 36 months), and the average time to union was 18.6 weeks. The average hospital stay was 7 days, which is approximately one half the average stay reported in the literature for treating this kind of injury with delayed nailing. The shorter hospital stay represents potential savings of up to $9,000 per patient. Immediate intramedullary rodding is a safe, effective, and economic option for the treatment of a femoral shaft fracture caused by a low-velocity gunshot wound. However, a lack of compliance with instructions concerning weight-bearing in this patient population needs to be taken into account when planning postoperative care.