Paper| Volume 26, ISSUE 4, P257-259, May 1995

Immediate intramedullary nailing of femoral shaft fractures due to gunshots

  • R.M. Nicholas
    Requests for reprints should be addressed to: Mr R. Nicholas, The Fracture Clinic, Royal Victoria Hospital, Belfast BT12 6BA,Northern Ireland, UK. 0938 0810
    The Fracture Clinic, Royal Victoria Hospital, Belfast,Northern Ireland, UK
    Search for articles by this author
  • G.F. McCoy
    The Fracture Clinic, Royal Victoria Hospital, Belfast,Northern Ireland, UK
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.


      With increasing violence in our society, the number of gunshot fractures is likely to increase. Fourteen femoral fractures caused by gunshot injuries were treated with statically locked intramedullary nailing within 8 h of injury. Three patients had concomitant femoral arterial injuries. At follow-up (average 22 months) the results were assessed using a standardized grading system. Thirteen fractures had progressed to stable bony union and there were no deep infections. Nine fractures had an excellent outcome and four a good outcome. One fracture was graded as a poor outcome because of a non-union which was treated with an exchange nailing procedure and progressed to bony union. Our experience of immediate intramedullary nailing of gunshot femoral fractures has yielded results which approximate to those observed in treating closed femoral fractures. We would therefore recommend this as the treatment of choice in fractures of the femoral shaft caused by gunshots.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wiss DA
        • Brien WW
        • Becker V
        Interlocking nailing for the treatment of femoral fractures due to gunshot wounds.
        J Bone Joint Surg [Am]. 1991; 73A: 598
        • Hollmann MW
        • Horowitz M
        Femoral fractures secondary to low velocity missiles: treatment with delayed intramedullary fixation.
        J Orthop Trauma. 1990; 4: 64
        • Renner NL
        • Zych GA
        Treatment of civilian gunshot fractures of the femoral shaft.
        Helv Chir Acta. 1991; 58: 683
        • Bergman M
        • Tornetta P
        • Kerina M
        • et al.
        Femur fractures caused by gunshots: treatment by immediate reamed intramedullary nailing.
        J Trauma. 1993; 34: 783
        • Winquist RA
        • Hansen ST
        Comminuted fractures of the femoral shaft treated by intramedullary nailing.
        Orthop Clin North Am. 1980; 11: 633
        • Grosse A
        5th ed. Manual for Osteosynthesis for Femoral and Tibial Shaft Fractures. Howmedica International, Kiel1991
        • Barros D'Sa AAB
        The rationale for arterial and venous shunting in the management of limb vascular injuries.
        Eur J Vasc Surg. 1989; 3: 471
        • Barros D'Sa AAB
        • Hassard TH
        • Livingston RH
        • et al.
        Missile-induced vascular trauma.
        Injury. 1980; 12: 13
        • Elliott JRM
        • Templeton J
        • Barros D'Sa AAB
        Combined bony and vascular limb trauma: a new approach to treatment.
        J Bone Joint Surg [Br]. 1984; 66B: 281
        • Hampton OP
        The indications for debridement of gunshot (bullet) wounds of the extremities in civilian practice.
        J Trauma. 1961; 1: 368
        • Christie J
        • Court-Brown C
        • Kinninmonth AW
        • et al.
        Intramedullary locking nails in the management of femoral shaft fractures.
        J Bone Joint Surg [Br]. 1988; 70B: 206