Kuntscher Nail: A Forgotten Entity Yet A Reliable Modality In Treatment Of Winquist Type I And Ii Closed Femoral Shaft Fractures

BackgroundInterlocking intramedullary nail is used for almost all types of femoral shaft fractures worldwide because of its better mechanical stability. In countries like India with limited healthcare infrastructure, the use of Kuntcher nail (K-nail) in Winquist type 1 and type II isthmic fractures is still debated. Therefore, we conducted this study to compare the functional outcome, radiation exposure, and cost of the implant between closed reduction and internal fixation of Winquist type I and II fractures in the middle one-third shall region by K-nail and intramedullary locked nails (IMILN), respectively.MethodsThis was a hospital-based non-blinded randomized trial which included 56 patients with closed Winquist type 1 and 11 femoral shaft fractures of the middle one-third femoral shaft (isthmic and paraisthmic zone). All the patients were either treated by K-nail or IMILN. The patients were followed up every three weeks for the initial six months and quarterly thereafter. Per operative duration of surgery and radiation exposure by C-arm was documented and assuming scattered radiation 20%, radiation exposure to the surgeon was calculated and patients were assessed clinically and radiologically for union.ResultsThe patients were divided into two groups: group I (K-nail, n = 25) and group II (IMILN, n = 31). In groups I and II, the patients achieving radiological union were 88% (n = 22/25) and 84% (n = 27/31) at six months' duration, respectively. The mean duration for the radiological union was 3.65 +/- 0.55 months in group I (K-nail) and 3.76 +/- 0.59 months in group II (IMILN), respectively. There was no statistically significant difference in the duration of the union (p = 0.4963). The average number of C- arm exposures was 16.3 +/- 63.18 in group I as compared to 27.29 +/- 4.01 in group II, and the mean scattered radiation was 5.0 +/- 1.63 in group 1 and 6.61 +/- 4.06 in group II. This difference was statistically significant.ConclusionKuntscher intramedullary nailing can provide comparable rates of union as is achieved with interlocking intramedullary nailing with an advantage of less radiation exposure and duration of surgery, provided the patient selection is proper (isthmic and paraisthmic zone).