Intramedullary rod fixation of femoral shaft fractures: comparison of open and closed insertion techniques.

Meta-analysis of published series of intramedullary rod fixation in fractured femurs revealed significantly higher union rates, lower deep infection rates and a better range of knee motion when closed rather than open techniques of insertion were used. A separate retrospective review of 58 femoral fractures at one hospital showed outcomes consistent with those reported in the literature; these results were obtained during a 6-year period when staff were learning closed techniques. Technical failures of the closed technique can be avoided by paying attention to well-established operative details. A system for grading outcomes was developed to compare objectively the results of treatment of fracture patients. The literature and the authors' experience support the adoption of closed techniques for intramedullary rod insertion in femoral shaft fractures.