Objective: To discuss the techniques and advantages of closed reduction and intramedullary nailing in treating femoral shaft fracture without cannulated femoral reamer.
Methods: From January 2006 to June 2007, 24 cases of femoral shaft fracture were treated with closed reduction and intramedullary nailing. Among them, there were 14 males and 10 females, with the average age of 38.3 years (ranging from 18 years to 63 years), with 7 left legs and 17 right legs. The average course of the disease was 7.6 days (ranging from 3 days to 20 days). According to the AO typing, there were 5 cases of type A, 6 of type B, 7 of type C1, 2 of type C2 and 4 of type C3. Closed reduction was achieved with manipulation and reaming of femoral canal was instructed by fluoroscopy.
Results: The operation time lasted from 100 minutes to 170 minutes, with the average time of 128.3 minutes. One patient was given a transfusion of 400 mL, and others were not. Twenty cases were followed up with the average time of 13.1 months (ranging from 6 months to 24 months). A mild to large amount of bony callus was showed on X-ray films 6 to 12 weeks postoperatively. Walking without crutches began at the average week of 22.2 (ranging from 15 to 30) postoperatively. Range of motion of the knee was 0 degrees to 145.5 degrees. No infection or break of the internal fixator occurred. Myositis ossificans with pain and insufficient flexion of hip (120 degrees) happened in 1 case and the pain disappeared after non-steroid anti-inflammatory drugs were taken. Nonsymptomatic myositis ossificans occurred in 2 cases and no treatment was needed.
Conclusion: Closed reduction and intramedullary nailing can help to protect the blood supply of fracture fragments and provide central fixation. The operation process will be more complicated if cannulated femoral reamer is not available.