FRACTURE: nailing in comminuted fracture femur
30 yr old female presented with
fall from height. She suffered closed fracture shaft of femur left side at prox
1/3rd amd mid 1/3rd junction. The fracture was badly
comminuted, without overlying wound (closed), and without any distal
neurovascular deficit. After stabilizing the patient, she was taken to
operation theatre. Traction was given on fracture table, under spinal
anesthesia. The fracture was reduced closed. Beaded guide wire was inserted
from entry point in piriformis fossa and reaming was done. Zimmer femur nail
was inserted in GK mode and 2 proximal – 2 distal screws inserted. GK mode
allows us to fix such proximal fractures which cannot be fixed using
conventional femur nails. Other option that could have been used was RECON nail
but given a choice GK nails are preferred. RECON nails are technically more
demanding, more radiation exposure in there, surgical time is increased, and a
theoretical risk to blood supply of head of femur is there. Therefore for such
fractures, GK nails are best. Adequate alignment was achieved and fracture
fixed stably. Fracture union is demonstrated in sequential x rays. Another
significant point is importance of fixing comminuted fractures with nail rather
than plate fixation. There is no loss of hematoma, no loss of soft tissue attachment of small fragments and
minimal blood loss, all contributing to increased chances of union without need
of bone grafting.