Comparison of two kinds of intramedullary nails in the treatment of femoral shaft fractures in adults

Background Intramedullary nails have been widely used in treating femoral shaft fractures.However,end caps falling into soft tissue intraoperatively may cause trouble to surgeons,prolong operative time and increase radiation exposure.Additionally,difficulties may be encountered when removing nails because of callus formation over the nail tip.We performed a prospective study to compare two types of nails in managing femoral shaft fractures.Methods Group I consisted of seventy-four patients with unilateral femoral shaft fractures treated with cannulated interlocking anatomical femoral intramedullary nails.Group Ⅱ consisted of seventy-eight patients treated with cannulated interlocking anatomical femoral intramedullary nails with tail wires.The patients' ages,fracture severity,duration of operation,fluoroscopy time,blood loss and falls of end caps into soft tissue were recorded.Nails were removed after fracture healing.The duration of operation and blood loss during nail removal were recorded.Results There were no significant differences between groups with respect to age and fracture severity (P＞0.05).End caps fell into soft tissue 17 times in 15 cases in group Ⅰ and 21 times in 16 cases in group Ⅱ.An average of seven minutes was spent recovering a lost cap in group Ⅰ.In group Ⅱ,all lost caps were recovered immediately.The duration of operation and fluoroscopy time in group Ⅱ was significantly less than in group Ⅰ (P ＜0.05).Asymptomatic palpable nodules were detected in 4 cases in group Ⅱ.Nail removals were performed on 58 patients in group Ⅰ and 69 patients in group Ⅱ.The duration of operation,blood loss and complications in group Ⅱ were less than in group Ⅰ (P＜0.05).Conclusion Intramedullary nails with tail wires facilitate both fracture fixation and nail removal,which can be used to treat femoral shaft fractures with less radiation exposure,shorter surgical time and fewer complications.