Comparison of Open vs. Closed Rodding of Femurs Utilizing a Sampson Rod

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Abstract
The purpose of this study is to compare results in fractured femurs treatd with intramedullary rods inserted by the closed technique to those repaired by the open technique. There is very little information comparing the 2 types of techniques with a single fixation device. Patients (62) with fractures of the femur were treated with the fluted intramedullary (Sampson) rod. Of the total group 17 had the rod inserted by the closed technique; 23 patients were treated with an open technique. The entire group was analyzed with multiple parameters including X-ray evaluation of rate of healing, return to weight-bearing status and return to activity. The closed rodding groups were more closely analyzed clinically for knee and hip motion, shortening, strength, rotational problems, symptoms of the greater trochanter, fracture symptoms and shifting of the rod. Operative data were analyzed including blood loss, time of surgery, image intensifier time and operating room complications. In all the categories of comparison, the patients treated by the closed technique demonstrated an imporved clinical result compared to those treated with the open technique. Specifically, at 6 mo. 100% of the former group of patients were found by X-ray to have mature healed callus at the fracture site; in the latter group 30-40% of the patients had arrived at this level of healing by 6 mo. One patient treated by the open technique went on to nonunion. The closed group ambulated without support in 12 wk, and the open group required 16 wk to achieve this level. Close clinical followup of the closed insertion group revealed that the patients demonstrated excellent results. Problems detected at followup were: one patient with an external rotation contracture of 10.degree., 2 patients with 4 cm of shortening, and 3 patients with 3 cm of shortening. Fractured femurs are more effectively managed by the closed insertion of the intramedullary rod compared to the open method of insertion.

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