[Intramedullary nailing in closed femoral fractures]

Intramedullary nailing of femoral fractures has gone through a revival in the past few years because of improvements in both materials and design. Axial forces are tolerated very well by the nail; however, its stiffness in both rotation and bending is related inversely to its working length. Fractures of the middle shaft can be stabilized without problems due to elastic contact forces that result in a tight grip inside the bone. Reaming and interlocking extend the indications to more complicated fractures. The development of solid nails with augmented stiffness, but smaller diameter, permits unreamed nailing with reduced damage to the medullary cavity and the avoidance of dead space. The AO developed a modular solid nail system with a variety of interlocking possibilities. With respect to soft tissue injury and biomechanics, nailing is the procedure of choice for femoral fractures.