Treatment of femoral shaft fractures with the Brooker-Wills interlocking intramedullary nail.

Fifty femur fractures were treated with the Brooker-Wills intramedullary locking nail. The indications included subtrochanteric, subisthmal, segmental or comminuted acute fractures or nonunions, and intramedullary shortening procedures. Eighteen technical problems in 13 (26%) patients were encountered during insertion of the nail. The incidence of technical problems was high early in the series and in procedures done with the patient in the supine position. Adverse clinical results from technical errors occurred in two patients. Most technical errors seem avoidable with careful technique. The mean healing time was only 12.1 weeks and there were four nonunions (8%). One patient had a 10 degrees malunion, four patients had 1-2 cm of shortening, and there were two late device fractures. No patients had rotational malalignment or deep infections. The results and complication rate are comparable to those reported for other interlocking systems. The Brooker-Wills nail is useful for treatment of complex femur fractures and has been effective in preventing malrotation, angulation, and excessive shortening.