Twenty consecutive multiply injured patients who had a total of
twenty-two fractures of the femoral shaft were managed with intramedullary
nailing without reaming. A retrograde technique through the intercondylar
notch of the knee was used. All patients were followed for at least one
year or until union of the fracture. The operative time for the nailing
averaged seventy-five minutes (range, thirty-five to 105 minutes). Union of
the fracture occurred at an average of fifteen weeks. There were three
non-unions and one rotational malunion. There were no infections, and no
nail or screw failed. Normal motion of the knee was regained by all
patients, except one who had had an ipsilateral dislocation of the knee. On
the basis of these preliminary results, we concluded that retrograde
nailing is a safe and effective technique for multiply injured patients.
The apparently higher prevalence of non-union compared with that reported
with antegrade nailing with reaming warrants additional study.