The treatment of femoral shaft fractures by closed Küntscher nailing (without reaming)

Closed medullary nailing for fracture of the femoral shaft was carried out in 101 cases. The operation was performed with the patient in the supine position and without reaming the medullary canal, using the conventional instruments and rigid guide pins. The diameter of the medullary canal was gauged from standard radiographs taken at 1 m tube-to-film distance. To secure alignment and reduction of the fracture, heavy traction before and during the operation was necessary. The traction applied on a fracture table against the restraining perineal bar caused trauma to the perineal structures in 7 cases. There was no case of deep infection. The fixation of the fracture was by no means rigid but was adequate for early walking and partial weight bearing. When nails with diameters of less than 9 mm were used, a number of complications occurred. These included angulation, rotational instability at the fracture site, fracture of the nail and non-union. Union occurred within 3 months in all except 2 cases. Nearly 60 per cent of the patients were in hospital for less than 2 weeks. Closed medullary nailing of the femur is preferable to the open method, which carries a much higher risk of infection.