Problems in intramedullary nailing of femoral fractures.

Intramedullary nailing, an improved method for treatment of fractures of the shaft of the femur, is still in a transitional stage. Experience in 35 cases indicates that supplementary fixation as safeguard against sepparation or overriding often is advisable, particularly in the presence of considerable fragmentation. Wire loops, cross screws and, in some cases, a Collins band modified in such a way as to avoid occlusion of blood supply, have been used for this purpose. For strength and rigidity, the rod used should be as great in diameter as the medullary space can accommodate. A method of preoperative determination of the size of rod to use has been devised. As the intramedullary rod may bend or break, it is advisable that patients be cautioned against full weight bearing on the injured leg too soon after operation.