The use of the unreamed AO femoral intramedullary nail with spiral blade in nonpathologic fractures of the femur: Experiences with eighty consecutive cases

Objective: To evaluate the unreamed femoral nail With spiral blade (UFN-SB) in the treatment of nonpathologic subtrochanteric and segmental femoral fractures. Design: Prospective follow-up of eighty consecutive fractures in eighty patients still alive at least ten months after the operation. Setting: Academic teaching hospital. Patients: Eighty patients with a subtrochanteric or segmental femoral fracture. Excluded were patients with pathologic fractures and those who died within ten months of the operation. Intervention: Unreamed femoral nail with spiral blade. Main Outcome Measures: Clinical and radiographic examination. Results: In seventeen fractures, the UFN-SB failed before bony union (21 percent): bending of the spiral blade, five times migration, nine times; and breakage, three times. Revision surgery was necessary in seven cases (9 percent). All complications except one were observed in elderly women with a Seins-heimer fracture type IIC or V. Nevertheless, all fractures healed within one year, including those that needed revision surgery. Conclusions: There is predictive value of the Seins-heimer classification as to outcome using UFN-SB. The UFN-SB is an option for the treatment of subtrochanteric or segmental fractures of the femur, especially in patients With a good quality of bone. The complications using this device are not caused by the learning curve, but by the characteristics of the implant and the type of fracture for which it is used. The implant should not be used in elderly women with a reversed oblique fracture or a subtrochanteric fracture with an intertrochanteric component.