Selected problems in the bone union of complicated diaphyseal fractures treated with interlocking nail.

Background. This article discusses the effectiveness and technical problems encountered in the union of complications of diaphyseal fractures treated with interlocking nail. Material and methods. Between 2000-2003 we operated 35 patients for pseudoarthrosis (humerus - 6, femur - 13, tibia - 16). In a one-step procedure a plate was removed from the humerus (3 patients) or femur (4 patients), a retrograde interlocking nail was introduced, and spongy grafts were applied. In the remaining patients an external stabilizer or ZESPOL outer plate were first removed; then, after soft tissue healing, an anterograde nail was introduced sequentially using a closed technique. This method of nailing was also used in patients with plates that had previously been removed. The Dencker classification was used to evaluate outcome. Results. We achieved bone union in all cases. We observed intra- and post operative complications in 5 cases: breakage of distal locking screws in 4 patients, and breakage of 1 tibial nail. In closed nailing we encountered major difficulties in passing through the sclerotic edges of pseudoarthrosis, and it also proved extremely difficult to maintain the right direction of the reamer without a guiding wire, which was crucial for a successful operation. Conclusions. Interlocking nailing is an efficacious method of treatment of complications in fracture healing, but in some cases closed nailing of pseudoarthrosis is difficult.