Open Reamed Femoral Intramedullary Nailing–Revisited

Abstract

Objective: Locked intramedullary nailing is the
preferred treatment for femoral shaft fractures but it
requires a relatively expensive implant. Patients have
to pay for the specialized implants and those who could
not afford the cost had open Kuntscher nailing. This
study was done to see the outcome of open Kuntscher
nailing for femoral shaft fractures with regard to
infection, time to union, limb shortening, malunion and
range of motion at the knee.
Method: Thirty-two patients with 34 femoral shaft
fractures underwent open Kuntscher intramedullary
nailing. Their average age was 23 years. Ten fractures
involved the upper third of the femoral shaft, 19 the
middle third and 5 the distal third. When categorized
according to degree of comminution there were 18 Type
I, 11 Type II and 5 Type III fractures. Comminuted type
IV fractures, per-trochanteric and supracondylar
fractures were not included in the study.
Results:  All 34 fractures healed on an average in 14
weeks. One patient developed deep seated infection.
There was one nail breakage at 10 weeks, which
required re-nailing. 6 patients had shortening of one
cm or less. No patient had symptomatic rotatory
malunion. All patients could fully squat at one year.
Conclusion: Kuntscher intramedullary nailing gives
good clinical results in fractures with minimal
comminution. Locked nailing is not essential for less
severely comminuted fractures.
Key words: Kuntscher nailing, femoral fractures

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