Adjunctive fixation in flexible intramedullary nailing of femoral fractures: a study of twenty-six cases.

Flexible intramedullary nailing has been shown previously to be an effective method of fixation of simple transverse fractures and those with unicortical comminution. Long oblique fractures and those with bicortical comminution had a tendency to shorten after simple nailing, usually requiring additional measures to prevent it. Preliminary cerclage wiring of long oblique components, screw fixation of supracondylar fragments, and limited plating of very comminuted cortex were successfully performed in 22 cases, and external fixation was successful following nailing in four cases of highly comminuted fractures. Adjunctive fixation in these cases could not itself provide stability at the fracture site, but simply converted an unstable fracture to a stable one; flexible intramedullary nailing provided further necessary fixation until the fracture healed, while allowing the patient's early mobility and ambulation.