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The treatment of fractures of the femoral shaft with the Brooker-Wills distal locking intramedullary nail

The Journal of Bone & Joint Surgery.  1986; 68:865-876 
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Abstract

Ninety-two fractures of the femoral shaft in eighty-five patients were followed after treatment with the Brooker-Wills distal locking intramedullary nail. Twenty-one (22.8 per cent) of the fractures were open and seventy-one (77.2 per cent) were closed; 84.8 per cent of the fractures were comminuted. All but one fracture united, in a mean time of 4.4 months. Four fractures healed with mild angulation, and three had shortening of more than one but less than two centimeters. Significant rotatory deformities did not occur. No patient required postoperative traction or external stabilization, and all but five patients regained a normal range of motion of the ipsilateral hip and knee. There were intraoperative technical problems in eleven patients (12.0 per cent) and postoperative complications in eighteen patients (19.6 per cent), including fourteen patients (15.2 per cent) with pulmonary emboli, infection, or heterotopic bone at the site of the insertion of the nail. Five patients (5.4 per cent) had postoperative complications that were directly related to the proximal and distal fixation of the nail. There was one non-union (1.1 per cent). No problems were encountered with removal of the nail. The Brooker-Wills distal locking intramedullary nail proved to be an effective device for the stabilization of fractures of the femoral shaft. The use of this modified Kuntscher nail with both proximal and distal fixation has been successful in preventing clinically significant femoral angulation, malrotation, and shortening and has allowed early mobilization of the patient.

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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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