Immediate intramedullary nailing of femoral shaft fractures due to gunshots.

With increasing violence in our society, the number of gunshot fractures is likely to increase. Fourteen femoral fractures caused by gunshot injuries were treated with statically locked intramedullary nailing within 8 h of injury. Three patients had concomitant femoral arterial injuries. At follow-up (average 22 months) the results were assessed using a standardized grading system. Thirteen fractures had progressed to stable bony union and there were no deep infections. Nine fractures had an excellent outcome and four a good outcome. One fracture was graded as a poor outcome because of a non-union which was treated with an exchange nailing procedure and progressed to bony union. Our experience of immediate intramedullary nailing of gunshot femoral fractures has yielded results which approximate to those observed in treating closed femoral fractures. We would therefore recommend this as the treatment of choice in fractures of the femoral shaft caused by gunshots.