Technique of using the AO-femoral distractor for femoral intramedullary nailing.

Immediate closed interlocking intramedullary (IM) nailing of femoral shaft fractures in polytraumatized patients using the fracture table may be difficult due to concomitant adjacent injury. We report on the technique of using the AO-femoral distractor for femoral IM nailing and our experience with 56 consecutive cases of IM nailing of the femur. The AO distractor is an alternative to the traction table. Unlike the latter, it does not rely on intact adjacent structures to distract the main fragments. Schanz screws are placed into the femur condyle and into the lesser trochanter. The fracture is distracted and reduced by manipulating the mobile elements of the device. The femur is aligned and stabilized while reaming and nailing commence. Between April 1988 and June 1992, 56 IM nailings were performed using the AO distractor for reduction: 41 for acute unstable fractures and 15 for corrective procedures. In 11 of 15 polytraumatized patients, the fractured femurs were nailed immediately. Intraoperatively, the distractor greatly facilitated fracture reduction and presented no problems for proximal or distal interlocking. Intraoperative complications included two fracture extensions during nailing and three rotational malalignments over 15 degrees. One nonunion occurred; otherwise, all fractures were considered healed within 16 weeks. No postoperative nerve palsies were recorded, and no infection occurred. Based on our experience, we believe that the AO distractor is a suitable alternative to the traction table as a distraction and reduction device and can be implemented in all nailing cases. We particularly recommend its use in polytrauma cases in which concomitant injury precludes the initial use of the fracture table.