A novel closed reduction technique for treating femoral shaft fractures with intramedullary nails: Kirschner wire and the fulcrum technique

Femoral shaft fractures (FSF) are usually treated with closed reduction and intramedullary nailing. In this study, we report a novel technique with Kirschner wire to achieve closed reduction. From January 2020 to January 2023, this technique was used on 32 patients with FSF (AO 32 A and 32 B). The fracture was reduced with a radiolucent traction table, 3.0 mm Kirschner wire and the fulcrum technique was conducted. The operative effect was evaluated on the basis of the operative time, reduction time, fluoroscopy time, and intraoperative blood loss. All 32 patients were treated by closed reduction. The mean operative time was 70.4 ± 12.3 minutes (range, 55-90 minutes), of which 15.2 ± 5.6 minutes (range 10-25 minutes) was used for fracture reduction. The mean intraoperative fluoroscopy times were 18.8 ± 4.6 times (range 15-26 times). The mean hemoglobin loss was 1.56 ± 0.84 g/dL (range 1.2-2.0 g/dL). The injured limb obtained excellent alignment after intramedullary nailing. All patients successfully completed a follow-up after fracture healing. The healing time ranged from 3 to 7 months. Displaced FSF (AO 32 A and 32 B) in adults can be treated by the fulcrum technique in a closed fashion and intramedullary nail fixation. This technique is easy to perform, does not increase the cost, can quickly obtain effective reduction, reduce the operation time and intraoperative fluoroscopy times, protect the blood supply of the fracture site, minimize the blood loss, and leads to excellent fracture healing.