Problems of Locked Intramedullary Nail Osteosynthesis of Tibial and femoral fractures Without Image Guidance

Purpose: Locked intramedullary nail osteosynthesis is a versatile procedure which is now the gold standard in the management of tibia and femur fractures. Achieving locking during intramedullary nail fixation is possible with the use of a targeting arm and without intra-operative imaging. Thisprocess however is not without complications.Methods: We prospectively evaluated 47 tibia and femur fractures in 40 consecutive patients who had locked intramedullary nail osteosynthesis using the Greens locked nailing system. Intra-operative complications were documented as they occurred.Results: The mean age of all patients seen was 35.4±2.2 years with a range of 17 to 75 years. The commonest intraoperative complication experienced was difficulty in achieving distal lock which occurred in 38.3% of all cases seen. Other complications included nail rotation (4.3%),perforation of tibial plafond (2.1%), missed proximal lock (2.1%) and missed distal fragment (2.1%).Conclusion: Radiation free locked intramedullary nail osteosynthesis is not without its own problems