Open Reamed Femoral Intramedullary Nailing–Revisited

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.