Current indications for open Kuntscher nailing of femoral shaft fractures

We retrospectively reviewed 32 patients with fractures of the femoral shaft treated with open kuntscher nailing. All fractures were simple transverse, short oblique or Winquist- Hensen type I and II comminuted diaphyseal fractures. Average operating time was 45 minutes (35 to 55 minutes). Patients were discharged from the hospital within 7 days of surgery. All fractures healed within 12-14 weeks and the union rate was 100%. One patient developed superficial wound infection. Two nails were too long proximally and two nails protruded into knee joints. There were no rotational deformities nor shortening. One patient had limited knee flexion (less than 60°) and one fracture united in 8° varus. We concluded that open Kuntscher nailing is still indicated in the following situations: in hospitals with no traction table and image intensifier, in obese patients, in Grade I and II compound fractures, in polytrauma patients, in irreducible fractures and in patients with vascular injuries.