Ultrasound-guided intramedullary nailing

A method of closed femoral unlocked nailing using ultrasound instead of the image intensifier for assessment of the fracture alignment in several steps from beginning to end is described. In a prospective study of this method in 102 cases of unilateral femoral shaft fracture, 92 procedures were successfully performed with this technique. The time required for the reduction of the fracture until the guide wire could be inserted into the distal fragment averaged 7.3 minutes (range, 1-14 minutes). The overall operation time averaged 40 minutes (range, 25-60 minutes). Of 10 failure cases, three were the result of soft-tissue interposition that required open reduction, four were the result of the fractures being unable to be reduced within 15 minutes of trial, two required fluoroscopic assessment because the guide wire could not be inserted into the distal fragment, and one required fluoroscopic monitoring during insertion of the nail because of impending incarceration of the nail. The method had been effective in 92% of cases with simple or minimal comminuted femoral shaft fractures that underwent closed unlocked nailing.