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O3116 COMPLICATIONS FOLLOWING THE USE OF MARCHETTI FLEXIBLE INTRAMEDULLARY NAIL IN FRACTURES OF THE FEMORAL SHAFT

Aims: The purpose of this retrospective review was to analyze our results with the use of the Marchetti-Vicenzi elastic locked nail in femoral shaft fractures. Methods: Between Jan.1994 and Dec.1997, 75 femoral fractures in 73 patients were treated in our department. There were 51 men and 22 women with a mean age of 29 years. All patients were followed to fracture union. In 67 cases (89%) the cause of injury was a R.T.A. According to Winquist and Hansen, there were 8 fractures of type 0 (no comminution), 5 of type I, 22 of type II, 29 of type III and 11 of type IV. Six fractures were open grade II and two were grade IIIa. Multiple injuries were seen in 22 patients (30%). Results: Certain intraoperative complications were encountered in 25 cases (33%). Open nailing was required in 21 fractures (28%) mainly because of the loss of reduction (absence of guide wire) or because the distal pins jammed at the fracture site. Distal locking mechanism problems (bending of protruding locking wire or breakage of safety loops) occurred in 11cases (15%). In 3 patients the distal pins protruded from the anterior cortex and in another 4 breakage of one or more pins occurred during the postoperative period. Delayed union was seen in 7 patients (9%). Five fractures (7%) progressed to non-union. All the non-united fractures were type III or IV. The remaining fractures united after a mean period of 15 weeks. Four fractures (5%) which were located in the distal third, united with signiþcant varus deformity (≥10i). Shortening (≥2 cm) were seen in 4 patients (5%). There was one deep infection that led to nonunion. Conclusions: Because of the high complication rate in this series, we do not recommend this type of elastic nail for the treatment of femoral shaft fractures.