Eighty-seven femur fractures treated with the Brooker-Wills distal fin deployment interlocking nail were analyzed for intraoperative technical problems. Only unstable fractures located distal to the lesser trochanter and proximal to a level 5 cm proximal to the distal epiphyseal scar were included. Seventeen fractures were subtrochanteric, 19 were comminuted diaphyseal, and 51 were subisthmal. The majority (73) were locked proximally and distally. Of the 87 procedures, 33 technical difficulties occurred in 24 cases, for an overall rate of 29%. These ranged from problems with fin deployment and proximal screw insertion to bending of the nail itself. Patient position and proper technique were significantly correlated with the incidence of technical difficulties.
Postoperative complications were few, with one angulatory malunion, five nonunions, two unacceptable shortenings, and no deep wound infections. Average healing time was 12 weeks. The nail functioned well in regard to fracture healing, which was not affected by the technical difficulties. A significant learning curve for nail insertion was demonstrated. The authors concluded that most of the problems encountered could be avoided by strict adherence to suggested technical details and lateral patient positioning.