LCP钢板和带锁髓内钉治疗新鲜胫骨干骨折的对比研究

目的回顾性分析LCP钢板和带锁髓内钉两种方法治疗新鲜胫骨干骨折的效果。方法2003年10月～2006年4月,收治55例胫骨干新鲜骨折患者。其中男39例,女16例;年龄14～62岁,平均39岁。左侧27例,右侧31例,其中3例为双侧。34处骨折采用带锁髓内钉固定治疗(髓内钉组),24处骨折给予LCP钢板内固定治疗(LCP组)。髓内钉组和LCP组伤后至手术时间分别平均为3d和3.1d。评估两组患者手术时间、膝、踝关节活动度、骨折愈合时间以及术后并发症。结果术后获随访8～26个月,平均13个月。手术时间髓内钉组为84.0±9.2min,LCP组为69.0±8.4min;平均住院费髓内钉组为19297.78元,LCP组为14116.55元,差异均有统计学意义(P<0.05)。髓内钉组膝关节屈曲为139.0±3.7°,LCP组为149.0±4.2°,伸直分别为4.0±0.7°和0±0.4°,差异均无统计学意义(P>0.05)。髓内钉组、LCP组踝关节背屈分别为13.0±1.7°、10.0±1.4°,跖屈分别为41.0±2.6°、44.0±2.3°,差异均无统计学意义(P>0.05)。骨折愈合时间LCP组略早,平均为3.1个月;髓内钉组平均为3.3个月。髓内钉组术后X线片示1例下肢短缩2.5cm,1例骨折延迟愈合,3例钉尾问题,1例旋转畸形(20°),6例膝前疼痛;LCP组1例开放骨折(AO分型为42B型)的患者术后1周发生感染,1例胫骨远端1/3骨折出现成角畸形。结论带锁髓内钉和LCP钢板内固定治疗胫骨骨折均可取得理想效果。两种方法在膝关节和踝关节背屈度及跖屈度方面影响很小,都可保证骨折愈合。LCP钢板内固定并发症较少,且在手术时间和住院费用上更加有优势。     

Treatment of humeral shaft delayed unions and nonunions with humeral locked nails

OBJECTIVE: To report experience with use of humeral locked nails in treating humeral delayed unions and nonunions. The following techniques yielded encouragingly good results: static locking, short-to-long segment nailing, bone grafting, fracture compression, and minimal surgical trauma. DESIGN AND METHODS: A total of 41 consecutive patients with 13 delayed unions and 28 nonunions were treated with humeral locked nails. Delay from trauma to surgery averaged 4.2 months for delayed union and 15.5 months for nonunion. The average age of patients was 50.2 years; average follow-up time was 23.2 months. There were 7 proximal-third fractures, 21 middle-third fractures, and 13 distal-third fractures. The antegrade approach was used for 13 fractures and retrograde for 28. Open nailing was performed in 39 fractures and closed nailing in 2. If the fracture motion was still present after nail insertion, axial compression of the fracture site was specially applied. Bone grafting was performed in the fractures with open nailing. Thirty-four fractures were nailed with 8-mm nails, and 7 fractures were nailed with 7-mm nails. RESULTS: With a single operation, all but two patients achieved osseous union in, on average, 5.6 months. One of these two patients eventually gained union after another surgery with fracture compression along the original nail and concurrent bone grafting. The second patient, undergoing hemodialysis for chronic renal failure, had persistent nonunion. At follow-up, for patients with antegrade nailing, all but four patients had less than 20 degrees limitation of shoulder abduction. For patients with retrograde nailing, all but two had less than 10 degrees limitation of elbow motion. Only the patient with persistent nonunion had continual pain and significant impairment of arm function. CONCLUSIONS: Humeral locked nailing seems to be effective for humeral delayed unions or nonunions. It may be an acceptable alternative for fractures unsuited for plate fixation, such as those with comminution, osteoporosis, or a severely adhered radial nerve.     

Prospective study of the clinico-radiological outcome of interlocked nailing in proximal third tibial shaft fractures

BACKGROUND: Almost 9% of tibial shaft fractures occur in the proximal third of the bone. In order to address the problems of mal-alignment and late loss of fixation, all the specific surgical techniques described in the literature were used in nailing these fractures in our study. METHODS: From December 2001 to December 2003, 45 consecutive patients with fracture of the proximal third of the tibial shaft underwent nailing. The clinico-radiological outcome of these cases and the complications encountered were analysed. RESULTS: The average time to knee mobilisation and partial weight-bearing walking was 3.2 days. The fractures had united at an average of 4.3 months. At the last follow up, the average lower extremity functional score was 96%. There were seven cases of malunion (15.56%), with three valgus and four apex anterior angulations. Delayed union necessitated open bone grafting in three cases, at an average of 6.3 months. At 8 months, one patient with delayed union experienced nail breakage across the weakest point, i.e. the dynamic screw hole. He underwent reamed exchange nailing and, 3 months later, the fracture had united. CONCLUSION: Meticulous intramedullary nailing of fractures of the proximal third of the tibial shaft, using all current surgical principles and techniques, has excellent clinico-radiological outcome and is relatively safe. We recommend a nail similar to a Sirus nail, but with a more proximal bend of the nail and no dynamic interlocking screw hole.     

Treatment of floating knee injuries through a single percutaneous approach

The current study is a review of 20 patients treated by percutaneous stabilization for a floating knee. All patients were treated with a retrograde femoral intramedullary nail and a small diameter tibial intramedullary nail through a 4-cm medial parapatellar tendon incision. The average Injury Severity Score was 19. Two patients died in the early postoperative period and one patient was lost to followup. The average time to union for the 17 remaining patients with femoral shaft fractures was 14.7 weeks. One patient required dynamization. Four of the 17 patients with tibia fractures required an exchange nailing procedure, one with bone graft, to achieve union. One patient required dynamization and one patient with bone loss required only a bone graft. The average time to union for the tibia fractures was 23 weeks. One patient achieved 115 degrees knee flexion and the remaining 15 patients had full knee motion by 12 weeks, which they were able to maintain. No patient had signs or symptoms of knee pain. This demanding surgical technique using a small incision has yielded good clinical results. Although it is an excellent treatment option for patients with ipsilateral femoral and tibial shaft fractures, the mortality and tibial fracture complication rates remain high.     

Open interlocked nailing without a targeting device or X-ray guidance for non-union of the femur: a case series

From October 2005 to August 2007, we operated on six patients who had femoral non-unions and performed interlocked intramedullary nailing without X-ray guidance or a targeting device. There were three fractures of the distal femur, two fractures of the mid-shaft and one of the proximal femur. Fatigue failure of a non-interlocked Kuntscher nail and one nail migration were the presenting features in two patients. The presence of sclerosis of the bone ends in four cases and a need for cancellous bone grafts at the site of non-union in all patients made wide dissection and open reduction unavoidable. There was a limb length discrepancy in all patients before surgical intervention. Partial weight bearing was commenced at 6 weeks post-operation. There was no case of wound infection. There was no misplaced screw. Minimum range of knee flexion was 105° at 2 months post-operation. These early results call for a closer look at this cheap, safe and effective means of handling femoral non-union in third world societies where there is paucity of instrumentation and implants for interlocked nailing.     

Successful use of reaming and intramedullary nailing of the tibia

The records and radiographs of 87 patients with 88 fractures of the tibial diaphysis who underwent intramedullary reaming and nailing were retrospectively reviewed. The mean patient age was 37 years. Seventy fractures were closed, and 18 were open. The indications for nailing were failures of closed treatment (n = 48), nonunions (n = 24), multiple injuries (n = 14), and fixation of osteotomy (n = 2). Seventy-six patients with 77 nails who were followed for an average of 26.2 months were studied. For acute fractures, the average time to complete clinical and radiographic union was 5.3 months. For established nonunions, the average healing time was 9 months. The only fractures that failed to unit were nonunions developing from previously open Type III injuries. Angular deformities greater than 5 degrees did not occur. Significant tibial shortening occurred in only one fracture. Decreased motion in the ankle or knee was present in six patients. Major complications as a result of tibial nailing occurred in three patients: two deep infections and one patellar tendon rupture. Minor complications included 10 patients with pain at the nail insertion site necessitating removal in four patients, three patients with transient sensory peroneal nerve dysesthesias, and one patient with a superficial wound infection that cleared with local care. Nine patients required reoperation. Intramedullary reaming and nailing of the tibia can be used advantageously in the treatment of difficult fractures of the tibial shaft and their sequelae. Attention to the technical details of nail insertion will minimize the most frequent complications.     

Suprakondyläre Femurfrakturen bei Knieendoprothesen Stabilisierung mit einem retrograden Verriegelungsnagel

The treatment of supracondylar fractures of the femur in total knee arthroplasty is still challenging, and a variety of methods has been recommended. In a retrospective analysis, we reviewed six patients (average age: 70.5 years) with this type of fracture that had been stabilized with a retrograde intramedullary locking nail [Green-Seligson-Henry (GSH) nail]. The fracture had occurred 34.5 months after implantation of total knee arthroplasty. The average time of the operation was 97.16 min. There were no intra- or postoperative complications. All patients could be followed up at 17.3 months on average. Fracture healing was uneventful in all six cases. The postoperative range of motion was similar to the prefracture level in five patients. One patient demonstrated a loss of extension (10 degrees) associated with a valgus malalignment of 10 degrees. According to our experience, retrograde intramedullary nailing of supracondylar fractures in total knee arthroplasty is a promising alternative, which allows closed reduction and preservation of the soft tissue envelope. Immediate mobilization with partial weight bearing is possible, and the rate of complications is low.     

Effectiveness of completely round nails with both-ends-threaded locking screws for tibial shaft fractures

BACKGROUND: Completely round nails, in contrast to conventional locked nails with surface grooves, for postoperative endosteal revascularization may increase the nail rigidity and decrease the manufacture cost. Both-ends-threaded screws with higher fatigue strength require smaller nail holes and can further increase the mechanical strength of the nails. METHODS: In this study, both-ends-threaded locking screws were used to treat 68 tibial fractures, including 56 acute fractures in 54 patients and 12 nonunions in 12 patients. There were 41 men and 25 women with a mean age of 39.6 years, and the average follow-up was 24 months. For acute fractures, there were 11 type I, 9 type II, 5 type IIIA, and 3 type IIIB open fractures. Acute fractures were treated with closed nailing. Five hypertrophic nonunions were treated with closed exchanged nailing, and seven oligotrophic nonunions were treated with open nailing and iliac bone grafting. RESULTS: With a single nailing procedure, 53 acute fractures and all nonunions achieved union with mean times of 17.4 weeks and 18.4 weeks, respectively. Three patients underwent exchange nailing and bone grafting and had eventual fracture union. Three fractures with compartment syndrome were treated with fasciotomy. Deep infection occurred in two open fractures but was successfully treated. Nail breakage occurred in one distal fracture and screw backout occurred in another, but fracture union was not affected. Recovery of joint motion was essentially normal in patients without knee or ankle injury. CONCLUSIONS: This study showed that completely round nails with both-ends-threaded locking screws could effectively treat tibial fractures. Completely round nails have the advantages of high mechanical strength and low manufacturing cost.     

Die operative Versorgung suprakondylärer Femurfrakturen bei liegender Knieendoprothese—"less invasive stabilization system" (LISS) oder retrograder Marknagel?

Retrograde intramedullary locking nailing as well as the LIS system are propagated as minimally invasive treatment options for distal femoral fractures following total knee arthroplasty. In a retrospective study, we reviewed the clinical results after operative treatment of 18 periprosthetic supracondylar femoral fractures. The fracture was stabilized with the less invasive stabilization system (LISS) in nine patients (average age: 80.3 years) and with a retrograde intramedullary locking nail in the remaining nine patients (average age: 76.8 years). The mean follow-up was 18.2 months (6-35 months).We did not find significant differences concerning the operation time (nailing 99.8 min vs 102.3 min with the LISS) or the length of stay in the hospital (nailing 10.6 days vs 12.7 days with the LISS). In one patient of the nailing group we found a valgus malalignment of 18 degrees. Seven patients in each group were satisfied with the clinical results. In one patient of the LISS group a revision due to an infection was necessary. In one patient of the nailing group a reosteosynthesis had to be performed. To sum up, both systems are useful tools in the treatment of dislocated periprosthetic fractures and both systems are not without any problems. However, under special consideration of the complications we found in our study, the LISS seems to be a better alternative in osteoporotic bone with a small distal fragment. The choice of the optimal implant should therefore depend on the type of fracture and knee arthroplasty, the type of bone, and the experience of the surgeon.     

Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients

BACKGROUND: From 1989 to 1997, 1507 fractures of the shaft of the femur were treated with intramedullary nailing at The R Adams Cowley Shock Trauma Center. Fifty-nine (4 percent) of those fractures were treated with early external fixation followed by planned conversion to intramedullary nail fixation. This two-stage stabilization protocol was selected for patients who were critically ill and poor candidates for an immediate intramedullary procedure or who required expedient femoral fixation followed by repair of an ipsilateral vascular injury. The purpose of the current investigation was to determine whether this protocol is an appropriate alternative for the management of fractures of the femur in patients who are poor candidates for immediate intramedullary nailing. METHODS: Fifty-four multiply injured patients with a total of fifty-nine fractures of the shaft of the femur treated with external fixation followed by planned conversion to intramedullary nail fixation were evaluated in a retrospective review to gather demographic, injury, management, and fracture-healing data for analysis. RESULTS: The average Injury Severity Score for the fifty-four patients was 29 (range, 13 to 43); the average Glasgow Coma Scale score was 11 (range, 3 to 15). Most patients (forty-four) had additional orthopaedic injuries (average, three; range, zero to eight), and associated injuries such as severe brain injury, solid-organ rupture, chest trauma, and aortic tears were common. Forty fractures were closed, and nineteen fractures were open. According to the system of Gustilo and Anderson, three of the open fractures were type II, eight were type IIIA, and eight were type IIIC. Intramedullary nailing was delayed secondary to medical instability in forty-six patients and secondary to vascular injury in eight. All fractures of the shaft of the femur were stabilized with a unilateral external fixator within the first twenty-four hours after the injury; the average duration of the procedure was thirty minutes. The duration of external fixation averaged seven days (range, one to forty-nine days) before the fixation with the static interlocked intramedullary nail. Forty-nine of the nailing procedures were antegrade, and ten were retrograde. For fifty-five of the fifty-nine fractures, the external fixation was converted to intramedullary nail fixation in a one-stage procedure. The other four fractures were associated with draining pin sites, and skeletal traction to allow pin-site healing was used for an average of ten days (range, eight to fifteen days) after fixator removal and before intramedullary nailing. Follow-up averaged twelve months (range, six to eighty-seven months). Of the fifty-eight fractures available for follow-up until union, fifty-six (97 percent) healed within six months. There were three major complications: one patient died from a pulmonary embolism before union, one patient had a refractory infected nonunion, and one patient had a nonunion with nail failure, which was successfully treated with retrograde exchange nailing. The infection rate was 1.7 percent. Four other patients required a minor reoperation: two were managed with manipulation under anesthesia because of knee stiffness, and two underwent derotation and relocking of the nail because of rotational malalignment. The rate of unplanned reoperations was 11 percent. The average range of motion of the knee was 107 degrees (range, 60 to 140 degrees). CONCLUSIONS: We concluded that immediate external fixation followed by early closed intramedullary nailing is a safe treatment method for fractures of the shaft of the femur in selected multiply injured patients.     

胫骨干骨折带锁髓内钉固定和钢板螺钉固定的对比研究

目的：对照回顾性分析带锁髓内钉和钢板内固定两种方法治疗胫骨干骨折的效果。方法：髓内钉组32例（35处骨折）,根据AO分型,42A型11处,42B型18处,42C型6处;钢板组42例（45处骨折）,42A型10处,42B型22处,42C型13处。平均伤后手术时间在髓内钉和钢板组分别为3d和3.5d。随访评估患者手术时间,活动度,愈合时间,术后并发症之间的差别。结果：术后平均随访13个月（8～26个月）。髓内钉组平均手术时间为84min,钢板螺钉组平均为93min。髓内钉组踝关节平均背屈度为13°（0°～20°）,钢板组为11°（0°～20°）;跖屈分别为41°（30°～50°）,47°（30°～50°）。愈合时间髓内钉组平均为3.3个月,钢板螺钉平均为3.5个月。术后X线片显示髓内钉固定有1例出现旋转畸形,钢板组有3例出现成角畸形,均为胫骨远端1/3骨折。结论：在治疗胫骨骨折方面,带锁髓内钉和钢板内固定两种方法都可以取得理想的效果。     

Double-plating of comminuted, unstable fractures of the distal part of the femur

The cases of nine patients who had a complex fracture of the distal part of the femur and a deficient medial-cortical buttress were reviewed. Stable fixation was not achieved with the lateral condylar buttress plate alone. Collapse of the distal fragment into varus angulation was noted intraoperatively, with the axis of rotation being the junction of the distal screws and the plate. Additional stabilization with a medial plate and a bone graft from the iliac crest was applied in all nine patients: in six, at the time of the index operation and in the remaining three, after the open wound and open fracture were considered clean. At an average duration of follow-up of twenty-six months (range, twenty-one to thirty-four months), all of the fractures had healed. Evaluation of the functional outcome revealed five good and four fair results. In three patients, less than 90 degrees of flexion of the knee was present and in six, the arc of flexion was limited to between 90 and 100 degrees. Additionally, four patients had an extensor lag of 5 degrees.     

Subtrochanteric femur fractures: a comparison of the Zickel nail, 95 degrees blade plate, and interlocking nail.

Seventy-nine nonconsecutive patients with subtrochanteric femur fractures were divided into three groups based on the method of fracture fixation. Group I consisted of 21 patients treated with a Zickel nail, Group II comprised 25 patients treated with a 95 degrees blade plate, and Group III included 33 patients treated with an interlocking nail. All patients in Group I and Group II had open reduction and internal fixation of their fractures. Ninety-four percent of the patients in Group III were treated by closed intramedullary nailing. The average operating times for Groups I, II, and III were 212, 272, and 181 min, respectively, while blood loss averaged 900, 1,500, and 600 ml for each group, respectively. Group I had one infection, ten malunions, and one nonunion. Group II had one infection, six malunions, and two nonunions. Group III had no infections, two malunions, and one nonunion. We conclude that closed interlocking nailing is the treatment of choice for acute nonpathologic subtrochanteric femur fractures in adults. There is decreased blood loss, reduced operating time, and fewer complications than with either the Zickel nail or the 95 degrees blade plate regardless of the fracture pattern or the degree of fracture comminution.     

Pelvifemoral external fixation for the treatment of open fractures of the proximal femur caused by firearms

Seventeen patients with open fractures of the upper third of the femur were treated using a pelvifemoral external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Sciatic nerve injury was present in five (29.4%); abdominal viscera and thoracic wall injuries were present in two patients (11.8%). There were no major arterial injuries. Full weight bearing was allowed after clinical and radiological bone healing (average 11.5 months). Chronic osteitis with fistula and sequestra developed in two (11.8%) patients. There were no nonunions and no refractures. Minor painless limitation of hip motion persisted in all patients. Upper-third femoral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted; therefore, stable fixation is difficult or impossible to achieve using external fixation with transfixation of the fracture site. On the other hand, the risk of infection is high following intramedullary nailing. Pelvifemoral external fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early patient mobilization.     

Retrograde nailing for distal third femoral shaft fractures: a prospective study

PURPOSE. To evaluate the postoperative knee function and results of unreamed retrograde nailing for distal third femoral shaft fractures. METHODS. Between January 2002 and 2003 inclusive, a consecutive series of 27 patients (with 28 fractures) who underwent retrograde nailing were prospectively evaluated. Outcome measures were union time, initiation of weight bearing, deformity and shortening, functional length of the nail, knee function assessed using a modified Knee Society Knee Score. Correlations between union time and other variables were also studied. RESULTS. In these patients 26 (93%) of the 28 fractures achieved union, of which 5 underwent dynamisation; the mean union time for the other 21 fractures was 4.4 months. Angular malalignment was present in 4 patients and shortening in 4 others. There was negligible correlation between union time and variables of nail-canal diameter mismatch, functional length of nail, fracture geometry, or initiation of partial weight bearing ambulation. Knee flexion of more than 100 degrees was achieved in 26 patients. 19 patients had anterior knee pain and 10 had instability. By the end of one year, excellent or good scores for pain and function were recorded in 77% and 73% respectively, of the 26 patients. CONCLUSION. In view of such favourable union rates but significant deterioration in overall knee joint function, at best retrograde nailing is a reliable alternative in the management of selected complicated fractures of the distal femoral shaft.     

External fixation of war injuries of the proximal femur

Seventeen patients with open fractures of the upper third of the femur were treated using a pelvifemoral external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Sciatic nerve injury was present in five (29.4%); abdominal viscera and thoracic wall injuries were present in two patients (11.8%). There were no major arterial injuries. Full weight bearing was allowed after clinical and radiological bone healing (average 11.5 months). Chronic osteitis with fistula and sequestra developed in two (11.8%) patients. There were no nonunions and no refractures. Minor painless limitation of hip motion persisted in all patients. Upper-third femoral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted; therefore, stable fixation is difficult or impossible to achieve using external fixation with transfixation of the fracture site. On the other hand, the risk of infection is high following intramedullary nailing. Pelvifemoral external fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early patient mobilization.     

Closed intramedullary tibial nailing. Its use in closed and type I open fractures

We present the results of using the Grosse-Kempf interlocking nail in the management of 125 closed and type I open tibial fractures. The mean time to union was 16.7 weeks and no fracture required bone grafting. Mobilisation of the patient and the range of joint movement were better than with other methods of treating tibial fractures. There was a 1.6% incidence of infection; 40.8% of patients had knee pain and 26.4% needed to have the nail removed. Other complaints were minor. We suggest that closed intramedullary nailing with an interlocking nail system is an excellent method of treating closed and type I open tibial fractures.     

Initial experience with a second generation locking femoral nail: the Russell-Taylor reconstruction nail

A series of 36 patients with 20 subtrochanteric fractures, 12 ipsilateral neck/shaft fractures, and five intertrochanteric fractures with shaft extension underwent closed intramedullary nailing with the Russell-Taylor reconstruction (RECON) nail. The average Injury Severity Score was 16, and seven of the fractures were open. All fractures were acute injuries, and all but one were treated within 24 hours of admission. Follow-up was obtained at three, six, nine, 12, and 24 months or until the fracture healed. The range of follow-up was one to three years. Complete follow-up was obtained in 33 of 36 patients. Union was achieved in all acute fractures. Shortening occurred in two cases and chondrolysis and avascular necrosis occurred in another patient. Excellent hip and knee range of motion were obtained except in a few cases of ipsilateral limb injuries. While many complex femoral shaft fractures can be treated successfully with first generation locking nails, this study demonstrates that second generation locking nails, such as the RECON nail, offer the added strength and design features necessary for more effective treatment of complex proximal and ipsilateral femoral neck/shaft fractures.     

Infection following intramedullary nailing of long bones. Diagnosis and management

In 30 patients (23 femurs and 7 tibias) with infection of long bone fractures following intramedullary (IM) nailing, the follow-up study ranged from eight to 84 months (mean, 20 months). Six patients retained active infection at the time of follow-up examination. Ununited fractures were present in four and sequestra in two patients. Stabilization for fracture healing after irrigation and debridement with appropriate systemic antibiotic therapy was the critical factor in the orthopedic management of this series of patients.     

Interlocking intramedullary nailing for ipsilateral fractures of the femoral shaft and distal part of the femur.

A review of the data on 684 fractures of the femur that had been treated with intramedullary nailing led to the identification of twenty-three patients who had had a fracture of the shaft of the femur with an accompanying ipsilateral supracondylar fracture (twelve patients, group I) or a concomitant ipsilateral intercondylar fracture (eleven patients, group II). The group-I fractures had been treated with interlocking nailing without supplemental fixation. In group II, ten fractures were stabilized with interlocking nailing and supplemental screw fixation and one, with interlocking nailing and a supplemental plate and screws. The average time to union for all fractures was nineteen weeks (range, twelve to thirty-six weeks), and the average duration of clinical and radiographic follow-up was thirty months (range, nine to fifty-nine months). In group I, alignment of the femur was within 5 degrees of normal in ten of the twelve fractures. In group II, seven intra-articular fractures healed in anatomical alignment, three had slight articular displacement (1.0 to 3.0 millimeters), and one had displacement of more than 3.0 millimeters. The average range of motion of the knee at the most recent follow-up was 0 to 120 degrees in group I and 0 to 115 degrees in group II. Two patients (both in group II) needed a reoperation for a previously unrecognized fracture of a femoral condyle in the coronal plane; post-traumatic arthritis developed in both. No patient in either group had loss of fixation or failure of the implant. We concluded that ipsilateral diaphyseal, supracondylar, and intercondylar fractures of the femur can be adequately stabilized with interlocking nailing and supplemental intercondylar screw fixation. The presence of a fracture in the coronal plane of a femoral condyle (AO type-B3 and type-C3 injuries) is a relative contraindication to the use of this technique.