What is a femur nail?

The femur or thigh bone is the largest bone in the body. The femoral stem or diaphysis is the long, straight middle part of the femur. Fractures of the femoral stem are usually the result of high-energy trauma, such as a road traffic accident.

Fractures of the femoral stem may be closed, with the tissue above intact, or they may be open, with the bone exposed, putting the person at great risk for wound infection and contamination. These fractures are generally classified according to the morphological characteristics of the fracture line. Common descriptors are transverse (short and horizontal), oblique (straight but not horizontal), spiral (coil shape), and comminuted (more than three fragments)

Fractures of the femoral stem are sometimes associated with multiple injuries (multiple injuries to three or more parts of the body), which can be life-threatening. These fractures can lead to severe permanent disability, such as limb shortening and rotational deformity of the leg. Other common complications of these fractures include infection, residual pain, delayed healing and non-union.

Most femoral stem fractures are treated surgically. 

Several studies have shown that early surgical stabilization is associated with reduced complications and mortality. An intramedullary nail is a metal rod that is inserted into the medullary cavity of the bone and through the fracture in order to provide firm support for the fractured bone. The intramedullary nail is now considered the "gold standard" for the treatment of femoral stem fractures. The benefits of intramedullary nailing include a short hospital stay, rapid fracture healing and early functional use of the limb.

There are many different types of intramedullary nails and related surgical techniques in use. 

A key controversy is whether the nail should be inserted at the knee and the root canal pushed upward (retrograde nailing) or at the hip and pushed downward (prograde nailing). The point of entry of the prograde nail (pear-shaped fossa versus greater trochanteric entry) is also controversial. Another issue is whether intramedullary nails should be inserted with or without reaming (the medullary cavity expands prior to nail insertion). Similarly, there is no agreement on the impact of different types of nails, such as interlocking nails (locking bolts placed on the bone at the end of the nail to hold it in place) or Ender's nails that.

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