ABSTRACT
The treatment of segmental multilevel fractures of the femur is problematic. Open methods of fracture fixation which strip the soft tissue attachments from the bone cause devascularisation of the middle segment. Mechanical fixation using 2 separate plates results in a stress riser. The use of closed intramedullary nail addresses some of the problems in this difficult group of fractures, preserving the soft tissue envelope and eliminating stress risers. However, vascularity of the middle segment may still be compromised.
Six cases of fractures of the femur that were segmental in nature or associated with a fracture around the hip were treated with a closed intramedullary locked nail. The average operating time was 123 minutes and there were no infections. Average time to union was 7.2 months. Two cases required re-operation, one to correct a residual internal rotation deformity and one required dynamisation to eliminate the gap at the fracture site.Closed locked intramedullary nailing of the femur has become the accepted means of treating fractures of the femur. The use of locking nails has extended the technique from stable diaphyseal fracture patterns to nearly all fractures of the femur except for fractures at the very end of the bone and intra-articular fractures.
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