Improved results in treatment of femoral shaft fractures with the unreamed femoral nail? A multicenter experience

Objectives: The first studies of intramedullary nailing with the Arbeidsgemeinschaft fur Osteosynthesefragen (AO) unreamed femoral nail in selected clinics showed favorable results. Daily practice, however, is that femoral fractures are treated in a variety of clinics by a mixture of surgeons, To evaluate whether similar results could be obtained in general practice, a prospective multicenter trial was undertaken, involving a variety of university and general hospitals in one country, Methods: Between August of 1994 and June of 1996, 122 patients with 129 traumatic femoral shaft fractures treated with the unreamed femoral nail in eight hospitals were included in this study. Patients who had a reoperation with an unreamed femoral nail or patients with a pathologic fracture of the femur were excluded from this part of the study. Of these patients, 58 patients had multiple injuries, and 33 of the fractures had open soft-tissue injury. Results: Postoperative infection occurred in four patients; the nail broke in one patient. In total, nine patients (6.6%) sustained general complications, five of which developed adult respiratory distress syndrome (3.6%), Non-union occurred in seven patients (5.1%) and delayed union occurred in four cases (2.9%) with a reintervention rate of 6.6%, Conclusion: In this study, a decrease in the number of patients who develop adult respiratory distress syndrome through the use of a thin unreamed nail could not be demonstrated. The promising early callus formation and good consolidation mentioned in previous studies could not be confirmed. We find that the technical and clinical results in this study of unreamed femoral nailing in a mixture of clinics and by a variety of surgeons are comparable to the results of reamed nailing in the literature and are not as favorable as in the previous reports.