Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. papehc@upmc.edu
Successful intramedullary nailing of difficult femoral fractures is predicated on achieving and maintaining reduction before reaming and implant insertion. Closed and percutaneous strategies are emphasized which preserve fracture biology and encourage primary union. However, open techniques are sometimes necessary to avoid postoperative deformity.