Intramedullary nailing was performed on 520 femoral fractures in 500
patients. The series included eighty-six open fractures and 261 comminuted
fractures. Closed intramedullary nailing was used in 497 femora and open
intramedullary nailing with cerclage wiring, in twenty-three. The union
rate was 99.1 per cent. The range of motion of the knee at follow-up
averaged 130 degrees. Complications included four infections (0.9 per
cent). Shortening of more than two centimeters occurred in ten patients
(2.0 per cent) and malrotation of more than 20 degrees was observed in
twelve patients (2.3 per cent). After prompt emergency measures had been
taken, routine treatment included strong preoperative traction followed by
accurate positioning of the patient on the operating table; selection of
the correct insertion point for a properly sized, prebent, flexible,
bullet-tipped nail; and accurate reduction of the fracture. Careful
rehabilitation of the patient also contributed to the excellence of the
results.