The treatment of fractures of the femoral shaft with the Brooker-Wills distal locking intramedullary nail

Ninety-two fractures of the femoral shaft in 85 patients were followed after treatment with the Brooker-Wills distal locking intramedullary nail. Twenty-one (22.8%) of the fractures were open and 71 (77.2%) were closed; 84.8% of the fractures were comminuted. All but one fracture united, in a mean time of 4.4 months. Four fractures healed with mild angulation, and 3 had shortening of more than 1 but less than 2 cm. Significant rotatory deformities did not occur. No patient required postoperative traction or external stabilization, and all but 5 patients regained a normal range of motion of the ipsilateral hip and knee. There were intraoperative technical problems in 11 patients (12.0%) and postoperative complications in 18 patients (19.6%), including 14 patients (15.2%) with pulmonary emboli, infection, or heterotopic bone at the site of the insertion of the nail. Five patients (5.4%) had postoperative complications that were directly related to the proximal and distal fixation of the nail. There was one non-union (1.1%). No problems were encountered with removal of the nail. The Brooker-Wills distal locking intramedullary nail proved to be an effective device for the stabilization of fractures of the femoral shaft. The use of this modified Kuntscher nail with both proximal and distal fixation has been successful in preventing clinically significant femoral angulation, malrotation, and shortening and has allowed early mobilization of the patient.