Treatment of femoral shaft fractures with a titanium intramedullary nail

Ninety-nine femoral shaft fractures were treated with locked intramedullary nails made from titanium alloy. One of the distal interlocking screws failed in six fractures (6%) and both screws failed in two fractures (2%). Delayed union was associated with all of the eight fractures that had locking screw failure. Young, heavier patients who had nails of small diameter had an increased risk of screw failure. Additional surgery was needed when both screws failed. The authors still use this nail, but currently prefer to ream the medullary canal more so that larger nails can be inserted. Decisions concerning weightbearing are made on an individual basis for each patient, and currently full weightbearing is delayed for young, active, and heavy patients. Two distal interlocking screws should be inserted for treatment of femoral shaft fracture when a Ti locked intramedullary nail is used.