Closed interlocking nailing of femoral shaft fractures: Assessment of technical complications and functional outcomes by comparison of a prospective database with retrospective review

Although closed interlocking femoral nailing is generally considered to be a difficult but effective procedure, the true incidence of technical complications has not been well documented. Similarly, long-term and functional patient-oriented data are limited. We reviewed our experience with an interlocking nail system that was introduced in our institution in October 1987. One hundred and twenty-three patients were retrospectively reviewed with particular attention to technical complications (Group I). A second group of 144 patients with femoral shaft fractures were reviewed prospectively as a part of our Orthopaedic Trauma Outcome Database (Group IIA). In the earlier retrospective group, the technical complications in 123 cases included one distal screw fracture, one broken drill bit left (in situ), one “missed” locking distal screw, and three cases where comminution at the fracture site was increased. In the prospective group of 144 fractures, the technical complications included two “missed” distal locking screws, two broken screws, and one bent nail due to additional secondary trauma. In a third group of 56 patients (Group IIB) selected from Group IIA, an abbreviated functional assessment was performed at a minimum of 12 months postinjury. Of this group, 37% of the patients had pain that was described as related to barometric changes and was either constant or activity related; 39% had some limitation in ability to ambulate or stand. Nine percent had to obtain new employment or seek job modifications. Based on our data we conclude that closed intramedullary nailing can be done at a Level I Trauma Center with relatively few technical complications, but the functional outcomes are not as good as had been previously believed. A significant portion of patients with femoral shaft fractures treated with interlocking nails will have permanent functional loss.