Double level fractures of the femur treated with closed intramedullary nailing

The treatment of segmental multilevel fractures of the femur is problematic. Open methods of fracture fixation which strip the soft tissue attachments from the bone cause devascularisation of the middle segment. Mechanical fixation using 2 separate plates results in a stress riser. The use of closed intramedullary nail addresses some of the problems in this difficult group of fractures, preserving the soft tissue envelope and eliminating stress risers. However, vascularity of the middle segment may still be compromised. Six cases of fractures of the femur that were segmental in nature or associated with a fracture around the hip were treated with a closed intramedullary locked nail. The average operating time was 123 minutes and there were no infections. Average time to union was 7.2 months. Two cases required re-operation, one to correct a residual internal rotation deformity and one required dynamisation to eliminate the gap at the fracture site.