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The Journal of Bone and Joint Surgery, Vol 70, Issue 10 1453-1462, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Intramedullary nailing of femoral shaft fractures. Part II: Fracture-healing with static interlocking fixation
RJ Brumback, S Uwagie-Ero, RP Lakatos, A Poka, GH Bathon and AR Burgess
Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems, Baltimore 21201.
A consecutive, prospective series of ninety-seven patients who had 100
fractures of the femoral shaft that were treated with static interlocking
nailing was analyzed to determine the incidence of union of the fracture
without planned conversion from static to dynamic intramedullary fixation
as a technique to stimulate healing of the fracture. Eighty-four patients
(eighty-seven fractures) were studied through union of the fracture
(average follow-up, fourteen months). Eighty-five (98 per cent) of the
eighty-seven fractures healed with static interlocking fixation. Two
patients needed conversion from static to dynamic interlocking fixation
because of inadequate fracture-healing; both progressed to uneventful
union. The time to full weight-bearing (average, eleven weeks) was
individualized for each patient and depended on the cortical contact of the
major fragments, the presence of bridging callus as seen on radiographs,
and the extent of other injuries of the ipsilateral lower extremity. No
deformation or failure of the static interlocking device developed after
early walking with weight-bearing, but fatigue failure of one nail occurred
in a non-ambulatory patient who had an intracranial injury. Pain related to
soft-tissue irritation by the prominent heads of the interlocking screws,
clinically presenting as bursitis or snapping of the iliotibial band, was
severe enough in six patients to necessitate removal of either the proximal
or the distal screw after union of the fracture. We concluded that static
interlocking of intramedullary nails in femoral shaft fractures does not
appreciably inhibit the process of healing of the fracture, and that
routine conversion to dynamic intramedullary fixation, although
occasionally necessary, need not be performed.
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