Executive Editor: Chris Colton, Rick Buckley

Authors: Peter V Giannoudis, Hans Christoph Pape, Michael Sch├╝tz

Femur shaft - Simple, spiral, distal 1/3 fractures - Antegrade nailing

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Aftercare following antegrade intramedullary nailing of simple spiral or oblique fractures

Compartment syndrome and nerve injury

Close monitoring of the femoral compartment pressures should be carried out, especially during the first 48 hours, to rule out compartment syndrome.

Functional treatment

Unless there are other injuries or complications, mobilization may be started on postoperative day 1. Static quadriceps exercises with passive range of motion of the knee should be encouraged. Shortly afterwards special emphasis should be given on active knee and hip movement.

Weight bearing

Full weight bearing may be performed with crutches or a walker.


Wound healing should be assessed regularly on a short-term basis within the first two weeks. Subsequently 6 and 12-week follow-ups are usually performed. If the fracture healing is not adequate, removal of the static locking screw can be considered to achieve increased load transfer through the fracture site. Additional autogenous bone grafting may sometimes be required.

Implant removal

Implant removal is not mandatory and should be discussed with the patient if implant-related symptoms are troublesome.

v2.0 2018-07-05