Expandable intramedullary nailing for tibial and femoral fractures: A preliminary analysis of perioperative complications

Objective: To report the results of using the expandable nailing system in the treatment of femoral and tibial shaft fractures. Design: Prospective, cohort series. Setting: Two level-1 university trauma centers. Participants: Forty-eight patients with acute, traumatic diaphyseal fractures of the tibia or femur. Intervention: Internal fixation of lower extremity long bone fractures using expandable intramedullary nailing. Main Outcome Measurements: Perioperative complications and time to healing. Results: Forty-nine long bone fractures were treated: 22 femoral fractures (OTA classification: 4 type A1, 6 A2, 7 A3, 1 B1, and 4 132) and 27 tibial fractures (OTA classification: 4 type A 1, 11 A2, 9 A3, 0 B1, and 3 B2). There were 13 open fractures and 37 closed fractures. Healing occurred in 37 (75%) fractures without additional interventions. There were 2 tibial delayed unions and 1 femoral and 1 tibial nonunion. Five tibial shaft fractures and 6 femoral fractures shortened by 1.0 cm or more postoperatively. In 3 tibias and 4 femurs, shortening occurred after fractures judged to be length-stable became unstable because of fracture propagation during nail expansion. Five tibias and 3 femurs were converted to standard locked nails because of shortening. The average time to healing, excluding nonunion, was 15 weeks in the tibia and 16 weeks in the femur. The expandable nail resulted in an unplanned reoperation in 12 cases (25%). Conclusion: We found a high complication rate because of shortening, which was independent of fracture classification. Consequently, we cannot recommend the use of an unlocked, expandable nail in diaphyseal fractures of the femur or tibia.