Selected Instructional Course Lecture   |    
Controversies in Intramedullary Nailing of Femoral Shaft Fractures
Philip Wolinsky, MD; Nirmal Tejwani, MD; Jeffrey H. Richmond, MD; Kenneth J. Koval, MD; Kenneth Egol, MD; David J.G. Stephen, MD, FRCS(C)
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An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

J Bone Joint Surg Am, 2001 Sep 01;83(9):1404-1415
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Intramedullary fixation with reaming is an excellent operative procedure that has revolutionized the treatment of fractures of the femoral shaft. Instead of being confined to bed in traction, patients can be mobilized on the first postoperative day. The expected union rate is between 95% and 99%, with infrequent malunion and infection, at least for closed fractures and for grade-1 and grade-2 open fractures. Stabilization of a femoral fracture within the first twenty-four hours after the injury has been shown to reduce morbidity and mortality in multiply injured patients. However, there are still controversial issues related to intramedullary femoral fixation. The present report addresses several of these issues, including the effect of intramedullary reaming on pulmonary complications and the rate of fracture union, whether a fracture table or a flat radiolucent table should be used for nail insertion, and whether the presence of a head injury alters the treatment selection.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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