The huckstep nail. Stable fixation of mechanically deficient femoral bone.

A Huckstep intramedullary nail was used to treat 23 fractures in which the femur was mechanically deficient due to pathologic fracture, nonunion, or complex fracture in osteoporotic bone. All nailings were performed by open surgery, and in some cases this was augmented by corticocancellous bone grafting. The Huckstep nail allows the use of multiple cross screws at 15-mm intervals, providing immediate and adequate stability with successful early postoperative weightbearing. The results at followup were good in functional and radiologic terms, with no cases of fixation failure or infection. The quality of instrumentation allowed the nail and screws to be inserted without difficulty; however, the straight profile of the nail may cause problems in the distal femur, as seen in 1 patient. The authors conclude that this device offers significant mechanical and practical advantages over most other forms of fixation, where early weightbearing is desired in the presence of deficient bone. It is not ideal for distal femoral fractures, particularly in the presence of excessive femoral bowing.