Fractures of the femur treated by open and closed intramedullary nailing using the fluted rod.

Fractures of the shaft of the femur were treated by intramedullary nailing using the fluted rod, and I compared techniques of closed nailing (eighty fractures) with open nailing (thirty-nine fractures). A larger percentage of fractures of the proximal one-third of the femur and of open and severely comminuted fractures were treated open, but no significant difference in the average time of hospitalization of the two groups was noted. Operative morbidity appeared greater for the fractures that were treated open, while intraoperative complications predominated in the fractures that were treated closed. The two groups had a similar incidence of postoperative complications except for rotational malunion, which occurred more frequently in the fractures that were treated closed. The time to full weight-bearing on the extremity, type and rate of callus formation, time to osseous union, and extent of residual disability also appeared similar. Although a closed technique continues to be preferred for the majority of fractures of the femoral shaft, an open technique appeared to have some advantage for the more severely comminuted injuries in terms of enhancement of stability of the fracture.