Fractures of the femoral shaft: a prospective study of closed intramedullary nailing, modified open intramedullary nailing, and cast-bracing.

One hundred twelve consecutive fractures of the femoral diaphysis were treated in a prospective study at Grady Memorial Hospital, a designated trauma center, during the three-year period 1978 through 1980. Fifty of these were treated by closed intramedullary nailing; all united. Of the rest, 20 were treated by modified open intramedullary nailing, and 42 by cast-bracing. Closed intramedullary nailing offered a significant reduction in hospitalization and healing times compared to the other two methods; however, the high cost of equipment, along with the added cost of reoperation to remove the nail, rendered cast-bracing economically superior. Fractures treated by modified open intramedullary nailing developed no infections, but these patients lost significantly more blood during operation than those treated by closed nailing. Because of the decreased hospitalization and healing times, we prefer the closed intramedullary nailing technic for use in selected femoral fractures treated during the acute phase by an experienced surgical team.