Intramedullary nailing of acute femoral shaft fractures using manual traction without a fracture table.

Intramedullary (IM) nails were prospectively placed in 32 consecutive femoral shaft fractures without the use of a fracture table. All fractures were reduced using manual traction. Pathologic and nonacute fractures and those requiring a reconstruction nail were excluded. The results are compared with results of two prior study groups from this institution that underwent IM nailing with or without a fracture table using a femoral distractor. Ten patients had unstable spine or pelvis fractures. Four nailings followed exploratory laparotomy. Twelve patients underwent two or more procedures on the lower extremities under the same preparation and drape. Six fractures were open. Sixty-seven percent of results were anatomic, 27% had < 5 mm lengthening/shortening or < 5 degree varus/valgus, and 7% had > 5 mm lengthening/shortening or > 5 degree varus/valgus. Average operative time was 95 min. No complications occurred that were attributable to the technique. Compared with the prior study groups, no statistical difference in the fracture types or results was found. However, operative time was significantly less in the manual traction group (p < .05). We feel that this technique is a safe, simple, and effective alternative to using a fracture table. The technique is especially useful in the polytrauma patient, significantly decreasing anesthetic time.