Closed intramedullary nailing of femoral shaft fractures in an echelon III facility

This study was performed to assess the safety of performing intramedullary (IM) nailing in an established echelon III theater hospital. Twenty-two patients (23 fractures) sustained subtrochanteric or diaphyseal femur fractures and presented to the Air Force theater hospital (AFTH) at Balad Air Base, Iraq, for definitive treatment. Sixteen grade IIIA open fractures underwent staged intramedullary nailing. Seven closed fractures were treated with either immediate or staged intramedullary nailing as facility operations tempo dictated. Definitive follow-up was only available for 8 fractures at 2 months and for 5 fractures at 6 months, but no patient was readmitted to any U.S. military hospital in Iraq for treatment of infection or intramedullary nail removal. Although the results are not conclusive, the authors suggest that intramedullary nailing may be performed with acceptable infection risk in an established echelon III facility. Further study will help to establish the efficacy of this treatment approach.