Immediate Closed Antegrade Ender Nailing of Femoral Fractures in Polytrauma Patients

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Abstract
Fifty-four trauma patients with 61 femoral fractures stabilized within the first 24 hours of admission by closed antegrade Ender nailing were included in this study. This technique involves the insertion of Ender nails from a portal at the proximal end of the femur through the piriformis fossa. The curved distal ends of the nails were distributed throughout the distal femur to achieve greater purchase in the enlarged medullary canal of the distal fragment. This technique was used in one proximal, 20 midshaft, 37 distal, and three segmental fractures. There were 51 closed fractures, eight Grade I open, and two Grade II open fractures. The average age of the patient was 26 years, and the majority had polytrauma. The operative procedure was well tolerated by this group of patients. Pulmonary care was improved by avoidance of traction and enhanced capability for mobilization. Forty-two patients with 49 femoral fractures were available for complete follow-up. Forty-five fractures healed with the average time to appearance of bridging callus being 33 days, and average time to full union remodeled callus being 5.9 months. There were four nonunions, one delayed union, and eight malunions. There were nail protrusions in 22 cases (19 proximal and three distal). Fourteen patients required a second operation for reimpaction of the protruding nails or premature nail removal. These results were inferior to those obtained with the use of the retrograde Ender nailing technique or the Kuntscher nail. This technique should be used only if other techniques are unavailable or inappropriate, and only for stable, noncomminuted fractures. Immediate closed intramedullary nailing did appear, however, to be an excellent technique for stabilization of femoral fractures in polytrauma patients. Further studies need to be performed to investigate the efficacy of standard and 'locking' Kuntscher nails for this purpose.

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