The Journal of Bone and Joint Surgery, Vol 68, Issue 6 865-876, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
The treatment of fractures of the femoral shaft with the Brooker-Wills distal locking intramedullary nail
GM White, WL Healy, RJ Brumback, AR Burgess and AF Brooker
Ninety-two fractures of the femoral shaft in eighty-five patients were
followed after treatment with the Brooker-Wills distal locking
intramedullary nail. Twenty-one (22.8 per cent) of the fractures were open
and seventy-one (77.2 per cent) were closed; 84.8 per cent of the fractures
were comminuted. All but one fracture united, in a mean time of 4.4 months.
Four fractures healed with mild angulation, and three had shortening of
more than one but less than two centimeters. Significant rotatory
deformities did not occur. No patient required postoperative traction or
external stabilization, and all but five patients regained a normal range
of motion of the ipsilateral hip and knee. There were intraoperative
technical problems in eleven patients (12.0 per cent) and postoperative
complications in eighteen patients (19.6 per cent), including fourteen
patients (15.2 per cent) with pulmonary emboli, infection, or heterotopic
bone at the site of the insertion of the nail. Five patients (5.4 per cent)
had postoperative complications that were directly related to the proximal
and distal fixation of the nail. There was one non-union (1.1 per cent). No
problems were encountered with removal of the nail. The Brooker-Wills
distal locking intramedullary nail proved to be an effective device for the
stabilization of fractures of the femoral shaft. The use of this modified
Kuntscher nail with both proximal and distal fixation has been successful
in preventing clinically significant femoral angulation, malrotation, and
shortening and has allowed early mobilization of the patient.
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