Flexible intramedullary nailing of femoral shaft fractures.

Simple flexible intramedullary nailing is a suitable method of fixation of femoral shaft fractures with stable configurations. Complications are rare when nailing is properly executed, and patients are able to ambulate and bear weight within days of surgery. Problems arise when simple nailing is used to fix femoral shaft fractures with unstable configurations. Sliding of nails out of portals, loss of fixation, malrotation, and knee pain often result. Therefore, adjunctive measures must be used in the fixation of unstable fractures. The technique of nailing is demanding. The surgeon must be familiar with the principles of intramedullary nailing and should observe several procedures before attempting to do one alone. Furthermore, it is advisable to start with simple nailing of fractures with stable configurations to gain experience and confidence before undertaking a more complex procedure in a fracture with an unstable configuration. Finally, it must be emphasized that the principles of intramedullary nailing are essentially the same for all intramedullary devices. It must be also emphasized that there is little room for fast, temporary nailings and that there is no substitute for solid, precise fixation. There is no difference between quick insertion of a Küntscher-type rigid nail without reaming and speedy flexible nailing--both are fast and both will result in failure of fixation. The surgeon should resist the temptation to do fast procedures.