1 3 Arch Orthop Trauma Surg DOI 10.1007/s00402-013-1775-9 TRAUMA SURGERY Intramedullary nailing without interlocking screws for femoral and tibial shaft fractures Dieuwertje L. Kreb · Taco J. Blokhuis · Karlijn J. P. van Wessem · Mike Bemelman · Koen W. W. Lansink · Luke P. H. Leenen Received: 12 November 2012 © Springer-Verlag Berlin Heidelberg 2013 and rotational instability. All patients returned to their pre- injury level of activity. Conclusion The use of intramedullary nailing without interlocking is associated with minimal complications in selected fractures. The advantages include a short operating time and the simplicity of its application. Keywords Intramedullary nailing · Diaphyseal fractures · Femur · Tibia Introduction Interlocked intramedullary fixation is considered the treat- ment of choice for diaphyseal fractures of the femur and tibia [1–3]. It allows early weight bearing and quick reha- bilitation, combined with a good healing rate and a low incidence of complications. When using an interlocked nail, proximal and distal locking screws are used to maintain length and rotational stability. Insertion of the distal locking screws often turns out to be the most demanding step of the procedure. Dif- ferent techniques such as targeting devices mounted onto the nail or onto the image intensifier have been proposed without success so far, and free-hand techniques are used for distal locking nowadays by most surgeons [4]. As a consequence, the placement of the locking screws is asso- ciated with significant radiation exposure and a longer operating time [5, 6]. Nerve damage causing numb- ness and pain as a result of the locking screws has been reported in the literature with an incidence between 3.7 and 30 % [7–10]. In our institution, shaft fractures of the femur and tibia with an intrinsic axial and rotational stability after introduc- ing an intramedullary nail are treated without interlocking Abstract Background Intramedullary fixation is the treatment of choice for diaphyseal fractures of the femur and tibia. Locking the implant can sometimes be cumbersome and time consuming. In our institution, fractures with axial and rotational stability are treated with intramedullary nailing without interlocking. Methods All consecutive patients presented in the Univer- sity Medical Center Utrecht from October 2003 to August 2009 with acute traumatic diaphyseal fractures of the tibia or femur that were considered axial and rotational sta- ble were included. They underwent internal fixation using intramedullary nails without interlocking. Patient records were evaluated for duration of surgery, perioperative com- plications, consolidation time and re-operations. Results Twenty-nine long bone fractures were treated in 27 patients: 20 men and 7 women, with an average age of 28.9 years (range 15.6–54.4). There were 12 femoral frac- tures and 17 tibial fractures. Sixteen fractures were closed and 13 were open (10 Gustilo 1, 3 Gustilo 2). The mean operating time was 43 min (range 18–68 min) for tibial fractures and 55 min (range 47–150 min) for femoral frac- tures. Postoperative complications occurred in six patients. Two patients (three fractures) were lost to follow-up. Heal- ing occurred in 25 of the 26 remaining fractures (96 %) without additional interventions. One tibia was second- arily converted to a standard locked nail because of axial D. L. Kreb (*) · T. J. Blokhuis · K. J. P. van Wessem · M. Bemelman · K. W. W. Lansink · L. P. H. Leenen Department of Surgery, University Medical Center Utrecht (UMCU), HP G04.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands e-mail: dl.tielgroenestege@gmail.com